Predictors of ineffectual radial arterial pressure monitoring in valvular heart surgery.
OBJECTIVE
Unexpected sustained underestimation of the central aortic pressure by the radial arterial pressure commonly develops following cardiopulmonary bypass (CPB) in valvular heart surgery (VHS), leading to an inappropriate use of vasopressors. The study aim was to identify clinical predictors leading to a sustained inappropriate difference between the radial and femoral arterial pressure (IDRF) in VHS.


METHODS
A total of 200 patients undergoing VHS was studied prospectively. Those patients who developed sustained IDRF (systolic IDRF > or =10 mmHg and/or mean IDRF > or =5 mmHg) from immediately after discontinuation of CPB until the end of the surgery were compared with patients who did not develop any IDRF.


RESULTS
Data from seven patients who required second aortic cross-clamping and re-CPB were excluded from the analysis; thus, data from 193 patients were analyzed. In total, 53 patients (27.5%) developed sustained IDRF, whereas 80 patients (41.4%) did not develop any IDRF. In multivariate analysis, female gender, the presence of atrial fibrillation and diuretic use were identified as independent preoperative predictors; longer-duration aortic cross-clamping and use of larger amounts of vasopressin during CPB were identified as independent operative risk factors of the sustained IDRF.


CONCLUSIONS
When an erroneously low radial arterial pressure is suspected following CPB in this subset of patients undergoing VHS, monitoring of the femoral or axillary arterial pressure should be considered to guide hemodynamic management, as there is an increased risk of persistence of this phenomenon.
Hong
Seong Wook
SW
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Shim
Jae Kwang
JK
Choi
Yong Seon
YS
Chun
Duk-Hee
DH
Kim
Jong Chan
JC
Kim
Bum Su
BS
Kwak
Young Lan
YL
D000368:Aged; D001366:Axillary Artery / Q000502:physiology; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D017534:Radial Artery / Q000502:physiology*