Cardiac output measurement during infrarenal aortic surgery: echo-esophageal Doppler versus thermodilution catheter.
OBJECTIVE
Aortic surgery is associated with various hemodynamic and cardiac output modifications. These disorders may be partly caused by blood flow redistribution between supra-aortic and descending aorta regions during clamping and unclamping. A new echo-esophageal Doppler (Hemosonic 100; Arrow, Reading, PA) calculates cardiac output from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. This calculation may be affected by blood redistribution during aortic clamping. The aim of this study was to compare cardiac output measured by echo-esophageal Doppler and by bolus thermodilution catheter during infrarenal aortic surgery.


METHODS
Prospective, observational study.


METHODS
University hospital, single institution.


METHODS
Twenty-two adult patients.


METHODS
Infrarenal aortic surgery.


RESULTS
Cardiac outputs monitored by both devices were highly correlated during the whole surgical procedure (r2 ranging from 0.54 to 0.76). Bland and Altman analysis showed absence of significant bias before and after clamping (ranging from 0.1 +/- 0.73 L/min to 0.18 +/- 1 L/min, p > 0.05) and a significant bias of 0.5 +/- 1.05 L/min (p < 0.05) during aortic clamping. Limits of agreement did not differ significantly during the whole surgical procedure (ranging from -1.36/2.19 to -2.23/2.49). During clamping and unclamping, changes in cardiac output obtained by both methods were positively correlated (r2 = 0.7).


CONCLUSIONS
Bias between both methods was clinically acceptable, and limits of agreement were not significantly modified by aortic clamping. However, larger studies including homogenous aortic pathologies are necessary to validate this method during infrarenal aortic surgery.
Lafanechère
Aurélie
A
Department of Anaesthesiology and Intensive Care, University Hospital Beaujon, Clichy, France.
Albaladejo
Pierre
P
Raux
Mathieu
M
Geeraerts
Thomas
T
Bocquet
Rémi
R
Wernet
Anne
A
Castier
Yves
Y
Marty
Jean
J
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D002302:Cardiac Output; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013815:Thermodilution / Q000379:methods*