title: Predictors of ineffectual radial arterial pressure monitoring in valvular heart surgery.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seong Wook
authors.initials: SW
authors.lastname: Hong
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Yong Seon
authors.initials: YS
authors.lastname: Choi
authors.forename: Duk-Hee
authors.initials: DH
authors.lastname: Chun
authors.forename: Jong Chan
authors.initials: JC
authors.lastname: Kim
authors.forename: Bum Su
authors.initials: BS
authors.lastname: Kim
authors.forename: Young Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: 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*