How reliable is radial artery pressure in minimally invasive cardiac surgery using peripheral perfusion?
Yoshitsugu Nakamura, Miho Kuroda, Yohei Kawatani, Yujiro Hayashi, Tetsuyoshi Taneichi, Yujiro Ito, Yuji Suda, Takaki Hori, Chihiro Shirai, Naoya Yamauchi.
Chibanishi general hospital, Chiba, Japan.
OBJECTIVE: It has been reported that radial artery pressure (RAP) can become lower than the central (aortic) perfusion pressure in cardiac surgery with cardiopulmonary bypass (CPB) via central cannulation. However, it is unknown if the same phenomenon occurs and to what extent, in minimally invasive cardiac surgery (MICS) using CPB with peripheral perfusion via femoro-femoral cannulation. This study assessed how well RAP tracked central perfusion pressure during MICS.
METHODS: Fifty-two consecutive patients undergoing MICS were prospectively included in this study. Average age was 65 +/- 14 years and male/female ratio was 29/23. Types of surgeries included 23 aortic valve replacements, 22 mitral valve surgeries +/- maze procedure, and 5 double valve surgeries. CPB was established via a femoral artery cannulation and femoral vein +/- internal jugular cannulation. Average CPB and cross-clamp time were 153+/-31 min and 118 +/- 30 min respectively. The lowest blood temperature during CPB was 32 °C. RAP was monitored via a 5 cm long 20 G catheter. Central perfusion pressure was approximated by femoral artery pressure (FAP), which was measured via a 15 cm long 3 Fr catheter.
RESULTS: Average systolic FAP was higher than RAP throughout surgery (p<0.01), and the pressure gradient (PG) between them varied with time (Figure 1). The PG was level at about 5 +/- 8 mmHg until declamping of the aorta then increased to a peak of 24 +/- 16 mmHg at CPB termination. After the CPB, the PG decreased gradually. 28 patients (54%) and 21 patients (40%) had maximum PG of more than 20 mmHg and 30 mmHg, respectively. Univariate analysis showed that longer CPB time and intraoperative use of vasodilator were predictors of PG greater than 20 mmHg. In multivariate analysis, the latter remained a predictor of PG greater than 20 mmHg.
CONCLUSIONS: In MICS, RAP does not reflect central perfusion pressure, especially after declapming. Intraoperative arterial pressure management based solely on RAP should be avoided.
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