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J Cardiothorac Vasc Anesth. 2019 Sep 27. pii: S1053-0770(19)30984-X. doi: 10.1053/j.jvca.2019.09.023. [Epub ahead of print]

Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery.

Author information

1
Department of Anesthesiology, Weill Cornell Medicine, New York, NY. Electronic address: lir9065@med.cornell.edu.
2
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
3
Department of Anesthesiology, New York University Hospital, New York, NY.
4
Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
5
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY.
6
Department of Anesthesiology, North Shore University Hospital, Manhasset, NY.

Abstract

OBJECTIVE:

This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population.

DESIGN:

This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019.

SETTING:

Weill Cornell Medicine, a single large academic medical center.

PARTICIPANTS:

The study comprised 119 patients undergoing elective cardiac surgery.

INTERVENTIONS:

Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery.

MEASUREMENTS AND MAIN RESULTS:

Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (<35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]).

CONCLUSIONS:

PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.

KEYWORDS:

cardiopulmonary bypass; pulmonary artery pulsatility index; right ventricular dysfunction

PMID:
31653496
DOI:
10.1053/j.jvca.2019.09.023

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