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 |
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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 |