title: Central-radial artery pressure gradient after cardiopulmonary bypass is associated with cardiac function and may affect therapeutic direction.
abstract: OBJECTIVE
  To investigate the risk factors involved in radial-femoral artery pressure gradient after cardiac surgery.
  
  
  METHODS
  In this retrospective study, we reviewed 412 cardiac surgeries with both femoral artery pressure and radial artery pressure monitoring before cardiopulmonary bypass. 138 patients had radial-femoral artery pressure gradient after cardiopulmonary bypass (group P) but 263 were not (group N). Their hemodynamic data and other demographic data were analyzed.
  
  
  RESULTS
  Phenylephrine usage was 1.7±1.1 mg in group N and 2.9±1.2 mg in group P (P<0.001). Total adrenaline usage was 229.2±116.9 µg in group N and 400.6±145.1 µg in group P (P<0.001). SBP gradient was -4±3, 14±9, 10±4, 0±11 mmHg in group P and -3±3, 0±1, -1±9, -6±4 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. DBP gradient was 3±3, -1±9, 4±5, 0±8 mmHg in group P and 3±3, 5±2, 7±5, 0±8 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. MAP gradient was 1±2, 4±6, 6±4, 0±8 mmHg in group P and 1±2, 3±1, 1±4, -2±5 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. Significant arterial pressure gradient emerged during discontinuation of CPB and at the end of surgery, which was more obvious in group P(P<0.01). CI was 2.0±0.3, 2.3±0.4,2.3±0.4, 2.2±0.4 L/min/m(2) in group P and 2.1±0.3, 2.8±0.5,2.8±0.5, 2.8±0.5 L/min/m(2) in group N at baseline, after discontinuation of CPB, at the end of surgery and the first postoperative day (P<0.001).
  
  
  CONCLUSIONS
  Detecting the exact central artery pressure is most important when patients have artery pressure gradients after cardiac surgery. Use inotropic agents to improve cardiac output, avoiding excessive vasoconstriction might reduce artery pressure gradient.
authors.affiliation: Department of Anesthesiology, the First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Sun
authors.forename: Zhengnian
authors.initials: Z
authors.lastname: Ding
authors.forename: Yanning
authors.initials: Y
authors.lastname: Qian
authors.forename: Yong G
authors.initials: YG
authors.lastname: Peng
mesh_terms: D001794:Blood Pressure; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000502:physiology; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017534:Radial Artery / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013903:Thoracic Surgery
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