Clinical outcomes of low-risk patients undergoing beating-heart surgery with or without pulmonary artery catheterization.
OBJECTIVE
For patients who undergo off-pump coronary artery bypass (OPCAB) surgery, pulmonary artery catheterization (PAC) has been proposed as a useful intraoperative monitoring tool. This study was designed to determine if the choice of PAC versus central venous pressure monitoring (CVP) had any effect on outcome after OPCAB. This study compared these 2 methods of hemodynamic monitoring in low-risk patients undergoing beating-heart surgery via a median sternotomy and evaluated their effect on morbidity and in-hospital mortality.


METHODS
Retrospective database and medical record review.


METHODS
Tertiary care teaching hospital.


METHODS
Low-risk patients who had coronary revascularization via a median sternotomy on the beating heart.


METHODS
None.


RESULTS
A population of 2,414 low-risk patients who had beating-heart coronary revascularization between January 2000 and December 2003 was reviewed. Most patients (1,671 or 69.2%) received a PAC, whereas 743 (30.8%) had CVP monitoring. Risk-adjusted logistic regression analyses were performed to investigate the effect of each technique on clinical outcomes. The groups were comparable in both baseline characteristics and Parsonett's mortality risk (1.5 +/- 0.9, p = 0.58). Univariate analysis failed to show a difference in operative mortality (p = 0.76), on-pump conversion rate for completion of aortocoronary bypasses (p = 0.82), postoperative low cardiac output (p = 0.10), or prolonged inotropic agent use (p = 0.22). Similarly, in the multivariate analysis, both groups had a similar rate of conversion to an on-pump procedure for completion of coronary artery grafting (p = 0.91), intraoperative intra-aortic balloon pump use (p = 0.69), low cardiac output state (p = 0.16), or in-hospital mortality (p = 0.51).


CONCLUSIONS
This single-institution, retrospective study suggests that in low-risk patients undergoing beating-heart surgery, CVP monitoring may be sufficient.
Resano
Fernando G
FG
Department of Anesthesiology, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010-2975, USA. resano@medstar.net
Kapetanakis
Emmanouil I
EI
Hill
Peter C
PC
Haile
Elizabeth
E
Corso
Paul J
PJ
D000368:Aged; D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D012189:Retrospective Studies