Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery

Giglioli, Cristina and Cecchi, Emanuele and Stefàno, Pier Luigi and Spini, Valentina and Fortini, Giacomo and Chiostri, Marco and Marchionni, Niccolò and Romano, Salvatore Mario (2020) Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery. Journal of Cardiovascular and Thoracic Research, 12 (4). pp. 313-320. ISSN 2008-5117

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Abstract

Introduction: Studies have shown that a hemodynamic-guided therapy improves the post operative outcomes of high-risk patients.This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a post-cardiac surgery step-down unit (SDU), may identify patients at higher risk of 6-month adverse events after cardiac surgery.
Methods: From December 2016-May 2017,173 patients were admitted in SDU within 24-48 hours of major cardiac surgery procedure, and submitted to clinical, laboratoristic and echocardiographic evaluation and a 1-hour PRAM recording to obtain a “biohumoral snapshot” of individual patient’s.156 173 patients (17 patients were lost at follow-up) were phone interviewed six months after surgery,to evaluate, as a composite end-point, the adverse events during follow-up. A multivariable logistic regression analysis was used to identify a model clinical-biohumoral (CBM) and clinical-biohumoral hemodynamics (CBHM).
Results: No data from past clinical history and no conventional risk score (EuroScore II, STS score)independently predicted the risk of 6-month major events in our study. The risk of adverse events at six-month follow-up was directly related, in the CBM, to sustained post-operative cardiac arrhythmias, higher values of NT-proBNP and of arterial pH; inversely related to values of hs-C-reactive protein (hs-CRP) and, in the CBHM, to low values of cardiac cycle efficiency (CCE) and dP/dtmax.
Conclusion: Our study although limited by its observational nature and by the limited number of patients enrolled, showed that a short period of minimally invasive hemodynamic monitoring increased the accuracy to identify patients at major risk of mid-term events after cardiac surgery.

Item Type: Article
Subjects: Science Global Plos > Medical Science
Depositing User: Unnamed user with email support@science.globalplos.com
Date Deposited: 10 May 2023 10:18
Last Modified: 03 Feb 2024 04:32
URI: http://ebooks.manu2sent.com/id/eprint/758

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