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Placement of the Impella 5.0 percutaneous left ventricular assist device may cause aortic regurgitation (AR) due to malcoaptation of the aortic leaflets. The authors investigated the prevalence and severity of AR during Impella 5.0 support. Retrospective observational study. An academic hospital. A total of forty-two consecutive patients who underwent Impella 5.0 implantation from April 2018 to March 2022. None. To investigate AR prevalence, the authors calculated the AR volume by subtracting left ventricular inflow from left-sided systemic flow, the latter of which consisted of flow through the Impella 5.0 cannula and across the aortic valve. Because it is challenging to estimate flow across the aortic valve as distinct from that through Impella 5.0, the authors analyzed 19 of 42 patients whose aortic valves were closed (ie, those with no spontaneous cardiac output). AR due to Impella 5.0 was considered present if the AR fraction was ≥7%. The median AR volume was 0.6 L/min (interquartile range: 0.4-1.5 L/min), which was 13.5% (interquartile range: 11.0 to 30.6%) of the median Impella 5.0 flow. Seventeen of the 19 patients (89.5%) were diagnosed with AR during Impella 5.0 support, and the severity of AR was mild in 11 patients (57.9%) and moderate in 6 (31.6%). The authors revealed a high prevalence of AR during Impella 5.0 support in patients with no spontaneous cardiac output. Moreover, 31.6% of patients had moderate AR. [ABSTRACT FROM AUTHOR]

There is no definitive parameter for left ventricular (LV) preload in patients with a continuous-flow left ventricular assist device (LVAD). The intraventricular pressure difference (IVPD) is the maximum pressure difference between the mitral valve and LV apex during diastole; and, in past studies, the IVPD was influenced by volume loading. The authors hypothesized that IVPD in LVAD patients correlates with indexed LVAD flow and that IVPD can serve as a novel parameter of LV preload in this population. A single-center, retrospective, observational study. A tertiary-care hospital from August 2019 to July 2020. Sixteen ramp tests for adjustment of LVAD pump speed in 14 adult patients undergoing continuous-flow LVAD implantation. Measurement of IVPD during ramp tests. LVAD flow and IVPD were measured at each LVAD pump speed during the ramp test for the adjustment of LVAD pump speed after patients came off cardiopulmonary bypass during LVAD implantation. A straight, longitudinal view of the left atrium and left ventricle was obtained, and the pressure difference between the mitral valve and LV apex during diastole was measured by transesophageal echocardiography. The maximum pressure difference during diastole was recorded as IVPD. The relationship between indexed LVAD flow (LVAD flow/body surface area) and IVPD was assessed by a multivariate nonlinear regression analysis with the Huber-White sandwich estimator. IVPD correlated with indexed LVAD flow (p < 0.001). IVPD is a useful indicator of LV preload during LVAD implantation. [ABSTRACT FROM AUTHOR]

Investigate differences in the prevalence and severity of chronic postsurgical pain (CPSP) after cardiac surgery via thoracotomy versus sternotomy are not well-understood. An observational cohort study. A tertiary care hospital. Four hundred twenty-eight patients (sternotomy: 192 patients, thoracotomy: 236 patients) who underwent mitral valve repair. A questionnaire about the severity of surgical wound pain evaluated with a numerical rating scale (NRS) was sent. NRS responses for current pain, peak pain in the last four weeks, and average pain in the last four weeks were evaluated. The main outcomes were the severity of CPSP evaluated using NRS and the prevalence of CPSP. CPSP was defined as pain >0 that developed after a surgical procedure. During the median follow-up of 29 months, 79 patients complained of CPSP. (sternotomy: 15 patients, thoracotomy: 64 patients). Multivariate ordinal logistic regression showed that NRS responses for current pain (adjusted odds ratio [aOR], 3.17; 95% confidence interval [CI] 1.64-6.12; p = 0.001), peak pain in the last four weeks (aOR, 2.00; 95% CI 1.11-3.61; p = 0.021), and average pain in the last four weeks (aOR, 2.21; 95% CI 1.31-3.72; p = 0.003) were significantly higher in patients who underwent thoracotomy. Multivariate logistic regression showed that thoracotomy was an independent predictor of CPSP (aOR, 3.63; 95% CI 1.67-7.88; p = 0.001). The prevalence and severity of CPSP were higher among patients who underwent mitral valve repair via thoracotomy than sternotomy. [ABSTRACT FROM AUTHOR]

Balloon postdilation (BPD) is one strategy for decreasing paravalvular leakage, but its effect on long-term mortality remains unclear. The authors sought to clarify whether BPD influences long-term mortality of patients with transcatheter aortic valve replacement (TAVR). Single-center retrospective study. National heart center; single institution. Participants were patients who underwent TAVR in the authors' hospital from January 2014 to December 2016. A balloon-expandable Sapien XT or Sapien3, or self-expandable CoreValve or Evolute R, was implanted according to the decision of the surgeon considering degree of calcification of the aortic valve. No interventions. Multivariate Cox regression analysis and inverse probability weighted estimation were performed using a propensity score to examine whether BPD influenced six-year mortality. Ultimately, 180 patients were analyzed. During the follow-up period, with a median of 1104 (interquartile range: 730-1463) days, 41 patients died and cumulative incidence of mortality at six years was 22.8%. Society of Thoracic Surgeons score (odds ratio [OR]: 2.257, 95% CI: 1.213-4.197, p = 0.010)], BPD (OR: 0.306, 95% CI: 0.098-0.953, p = 0.041), and paravalvular regurgitation of at least moderate-to-mild severity after deploying (OR: 5.407, 95% CI: 1.626-17.978, p = 0.006) were significant factors of mortality. BPD is associated with reduced six-year mortality. [ABSTRACT FROM AUTHOR]

The ability of perioperative fluid management to prevent postoperative recurrence of atrial tachyarrhythmia remains controversial. The aim of the present study was to assess if intraoperative net fluid balance was associated with atrial tachyarrhythmia recurrence after the Cryo-Maze procedure. An observational cohort study. A tertiary care hospital from April 2007 to May 2019. Four hundred forty-four patients undergoing the Cryo-Maze procedure in conjunction with other cardiac surgeries. The Cryo-Maze procedure in conjunction with other cardiac surgeries. The main outcome was early atrial tachyarrhythmia recurrence, consisting of atrial fibrillation, atrial flutter, or atrial tachycardia, within the first three months after surgery. Complete follow-up was achieved in 443 patients (99.8%), of them 127 (28.6%) developed early atrial tachyarrhythmia recurrence. The median intraoperative net fluid balance was 1,627 mL (interquartile range, −215 to 3,557 mL). Multivariate logistic regression showed that intraoperative net fluid balance (p = 0. 001), preoperative AF duration (adjusted odds ratio, 1.40; 95% CI, 1.17-1.68; p < 0.001) and left atrial volume index (aOR, 1.61; 95% CI, 1.06-2.45; p = 0.025) were independent predictors of early atrial tachyarrhythmia recurrence. The adjusted log odds were lowest (–1.52) when net fluid balance was 1,557 mL. There is a significant U-shaped association between intraoperative net fluid balance and early atrial tachyarrhythmia recurrence among patients undergoing the Cryo-Maze procedure. [ABSTRACT FROM AUTHOR]

To clarify the association between anesthetic technique and maternal and neonatal outcomes in parturients with congenital heart disease (CHD). Retrospective, observational cohort study. An academic hospital. A total of 263 consecutive parturients with CHD who underwent cesarean section from 1994 to 2019. None. The authors compared postpartum cardiovascular events (composite of heart failure, pulmonary hypertension, arrhythmia, and thromboembolic complications) and neonatal outcomes (intubation and Apgar score <7 at one or five minutes) by anesthetic technique. Among 263 cesarean sections, general anesthesia was performed in 47 (17.9%) parturients and neuraxial anesthesia in 214 (81.3%) parturients. Cardiovascular events were more common in the general anesthesia group (n = 7; 14.9%) than in the neuraxial anesthesia group (n = 17; 7.9%). Generalized linear mixed models assuming a binomial distribution (ie, mixed-effects logistic regression), with a random intercept for each modified World Health Organization classification for maternal cardiovascular risk, revealed that general anesthesia was not significantly associated with cardiovascular events (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.30-3.29). In addition, general anesthesia was associated with composite neonatal outcomes (Apgar score <7 at one or five minutes or need for neonatal intubation; OR, 13.3; 95% CI, 5.52-32.0). Anesthetic technique is not significantly associated with postpartum composite cardiovascular events. General anesthesia is significantly associated with increased need for neonatal intubation and lower Apgar scores. [ABSTRACT FROM AUTHOR]

Objectives: The CNAP system is a noninvasive monitor that provides a continuous arterial pressure waveform using an inflatable finger cuff. The authors hypothesized that dramatic changes in systemic vascular resistance index during abdominal aortic aneurysm (AAA) surgery might affect the accuracy of noninvasive pulse contour monitors. The aim of this study was to evaluate the accuracy and trending ability of cardiac index derived by the CNAP system (CI CN) in patients undergoing AAA surgery. Design: Prospective clinical study. Setting: Cardiac surgery operating room in a single cardiovascular center. Participants: Twenty patients who underwent elective AAA surgery. Interventions: CI CN and cardiac index measured using 3-dimensional images (CI 3D) were determined simultaneously at 8 points during the surgery. At aortic clamping and unclamping, the authors tested the trending ability of CI CN using 4-quadrant plot analysis and polar plot analysis. Measurements and Main Results: The authors found a wide limit of agreement between CI CN and CI 3D (percentage error: 85.0%). The cubic splines, which show the relationship between systemic vascular resistance index and percentage CI discrepancy [(CI CN− CI 3D)/CI 3D ], were sloped positively. Four-quadrant plot analysis showed poor trending ability for CI CN at both aortic clamping and unclamping (concordance rate: 29.4% and 57.9%, respectively). In the polar plot analysis, the concordance rates at aortic clamping and unclamping were 15.0% and 35.0%, respectively. Conclusions: CI CN is not interchangeable with CI 3D in patients undergoing AAA surgery. The trending ability for CI CN at aortic clamping and unclamping was below the acceptable limit. These inaccuracies might be secondary to the high systemic vascular resistance index during AAA surgery. [ABSTRACT FROM AUTHOR]

To investigate the accuracy and trending ability of ClearSight (Edwards Lifesciences, Irvine, CA) in patients with reduced ejection fraction (<55%) undergoing off-pump coronary artery bypass graft (CABG) surgery by comparing the ClearSight-derived cardiac index (CI CS) with the cardiac index measured with thermodilution using a pulmonary artery catheter. In addition, the accuracy and trending ability of ClearSight for blood pressure measurement was investigated by comparing the mean arterial pressure (MAP) derived by ClearSight (MAPcs) with invasive intra-arterial pressure. Prospective clinical study. Cardiac surgery operating room in a single cardiovascular center. The study comprised 20 patients who underwent elective CABG surgery. MAP and cardiac index were measured simultaneously at 6 time points intraoperatively. Trending ability was investigated at the following 2 points: (1) before and after placing the patient in the Trendelenburg position and (2) before and after atrial pacing with a targeted heart rate increase of 20%. Bland–Altman analysis showed that the percentage error between CI CS and the cardiac index measured with thermodilution was 40.2% and the percentage error between MAPcs and MAP was 24.6%. Four-quadrant plot analysis showed that the tracking ability of CI CS with the Trendelenburg position and atrial pacing was below the good trending ability cutoff (92%). However, the concordance rate of the 4-quadrant plot analysis showed a good trending ability for MAPcs. The polar plot analysis showed the same trend. CI CS was not sufficiently accurate in patients with reduced ejection fraction undergoing off-pump CABG surgery. However, ClearSight was clinically acceptable for MAP regarding its accuracy and trending ability in patients with reduced ejection fraction. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) failure with pulmonary hypertension (PH) is frequently encountered in patients with advanced left-sided heart disease (LHD). However, RV energetics in patients with postcapillary PH because of LHD has not been well studied. The authors investigated intraoperative RV energetics in patients with PH due to LHD based on pressure–volume curves with three-dimensional transesophageal echocardiography and pulmonary artery catheterization. Exploratory study. National center. Thirty-three patients who underwent cardiac surgery for LHD were enrolled. Ten patients had PH (mean pulmonary artery pressure ≥ 25 mmHg). None. RV stroke work index (RVSWI) was calculated by integrating the area bounded by the pressure–volume curve. RV minute work index (RVMWI) was calculated as RVSWI × heart rate. Right ventriculo-arterial coupling was estimated as stroke volume divided by end-systolic volume (SV/ESV). The authors compared RV energetics between patients with and without PH because of LHD. RVSWI and RVMWI were significantly higher in patients with PH (690.7 mmHg·mL/m2 [601.6-737.1] v 440.9 mmHg·mL/m2 [330.8-585.3], p = 0.015, and 60,068 mmHg·mL/m2/min [35,547-68,741] v 26,351 mmHg·mL/m2/min [17,316-32,517], p = 0.011, respectively), although cardiac index was nearly identical. SV/ESV was significantly lower in patients with PH (0.520 [0.305-0.810] v 0.820 (0.650-1.090), p = 0.007). Although cardiac index was similar, RVSWI and RVMWI were significantly higher and SV/ESV was significantly lower in patients with PH because of LHD, suggesting that patients with postcapillary PH have inefficient RV performance. [ABSTRACT FROM AUTHOR]

High transprosthetic valvular peak velocity (PV) is indicative of prosthesis–patient mismatch (PPM), which exacerbates mortality and morbidity after surgical aortic valve replacement (AVR). During surgical AVR, a high intraoperative PV sometimes is detected, but whether it affects mortality and morbidity is unknown. The aims of this study were to determine whether intraoperative and postoperative PV were correlated and what factors predicted postoperative PPM. Retrospective, observational, cohort study. Tertiary medical center. None. The study comprised 556 patients who underwent AVR with a bioprosthetic valve. PV was measured intraoperatively, 1 month after surgery, and 1 year after surgery. The occurrence of PPM was defined as an effective orifice area index of less than 0.85 cm2/m2. The associations between PV values at the aforementioned 3 time points were analyzed using a multivariable nonlinear regression model. A multivariable logistic regression model was used to identify the predictors of PPM at 1 year. There was no significant association between intraoperative PV and PV at 1 month (p = 0.419) or 1 year (p = 0.115). The implanted valve type (p < 0.001) and size (p < 0.001), but not intraoperative PV (p = 0.503), were independent predictors of PPM. There was no significant association between intraoperative and postoperative PV values. Implanted valve type and size, but not intraoperative PV, predicted postoperative PPM. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. Design Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. Setting Four hospitals (1 national cardiovascular center and 3 university hospitals). Participants Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). Interventions Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. Measurements and Main Results Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score–matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. Conclusions Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients. [ABSTRACT FROM AUTHOR]

Objectives The authors stopped using tranexamic acid (TXA) in April 2013. The present study aimed to examine the impact of a “no-TXA-use” policy by comparing the adverse effects of TXA and clinical outcomes before and after the policy change in patients undergoing cardiovascular surgery. Design A single center retrospective cohort study. Setting A single cardiovascular center. Participants Patients undergoing cardiovascular surgery between January 2008 and July 2015 (n = 3,535). Interventions Patients’ outcomes before and after the policy change were compared to evaluate the effects of the change. Measurements and Main Results The seizure rate decreased significantly after the policy change (6.9% v 2.7%, p < 0.001). However, transfusion volumes and blood loss volumes increased significantly after the policy change (1,840 mL v 2,030 mL, p = 0.001; 1,250 mL v 1,372 mL, p < 0.001, respectively). Thirty-day mortality was not statistically different (1.6% v 1.4%, p = 0.82), nor were any of the other outcomes. Propensity-matched analysis and segmented regression analysis showed similar results. Conclusions The mortality rate remained the same even though the seizure rate decreased after the policy change. Blood loss volume and transfusion volume both increased after the policy change. TXA use provides an advantageous benefit by reducing the need for blood transfusion. [ABSTRACT FROM AUTHOR]

Objective Although motor-evoked potentials (MEPs) disappear in deep hypothermic circulatory arrest (DHCA), MEPs have been used to confirm whether motor function is intact after DHCA. It is crucial to know the timing, body temperature, and MEP amplitude at MEP reappearance to detect spinal cord ischemia after DHCA. However, data on these parameters are sparse. The authors investigated the characteristics of MEPs at reappearance after DHCA. Design A retrospective observational study. Setting Single national center. Participants Sixty-one patients who underwent descending aortic replacement and thoracoabdominal aortic replacement with DHCA between January 2013 and December 2015. Interventions None. Measurements and Main Results The authors extracted the following data: time to MEP reappearance after the end of lower extremity circulatory arrest, bladder temperature (BT) and nasopharyngeal temperature (NPT) when MEPs recovered, and %amplitude of MEPs relative to control values at MEP reappearance. The median time to MEP reappearance was approximately 70 minutes. BT at MEP reappearance ranged from 34.3°C to 34.6°C and NPT ranged from 36.2°C to 36.4°C. At MEP reappearance, %amplitude less than 50% of the control value was observed in more than 50% of patients. Time to MEP reappearance had a significant positive association with rewarming time (p < 0.01) and BT (p = 0.03). Conclusions There was a wide variation in MEP amplitude at reappearance during the rewarming phase. BT was approximately 34°C when MEPs in the leg recovered. The time to MEP reappearance is influenced significantly by rewarming time and BT. [ABSTRACT FROM AUTHOR]

Objectives The present study aimed to examine the association between tranexamic acid (TXA) use and adverse effects (seizures, thromboembolism, and renal dysfunction) in a pediatric cardiac surgery population using a national inpatient database in Japan. The authors also assessed the association between TXA use and other clinical outcomes (length of hospital stay and in-hospital mortality). Design A nationwide, retrospective cohort study using propensity score analyses. Setting Japanese Diagnosis Procedure Combination inpatient database. Participants Pediatric patients who underwent cardiac surgery using cardiopulmonary bypass between July 2010 and March 2014 (N = 11,275). Interventions None. Measurements and Main Results Propensity-score matching created 3,739 pairs of patients with and without TXA administration. Propensity-matched analysis showed that the proportion of seizures was significantly higher in the TXA group than in the non-TXA group (1.6% v 0.2%, difference, 1.4%; 95% confidence interval, 1.0-1.9; p<0.001). However, none of the other outcomes was significantly different between the groups. Conclusions TXA use is associated with a significantly increased risk of seizures. However, there is no difference in any other outcomes between the TXA and non-TXA groups. [ABSTRACT FROM AUTHOR]

Objectives To determine the accuracy and trending ability of the fourth-generation FloTrac/Vigileo in patients with low cardiac index by comparing FloTrac/Vigileo-derived cardiac index with that measured by 3-dimensional echocardiography. Design Prospective clinical study. Setting Cardiac surgery operating room in a single cardiovascular center. Participants Twenty-five patients undergoing elective cardiac resynchronization therapy lead implantation. Interventions FloTrac/Vigileo-derived cardiac index and 3-dimensional echocardiography-derived cardiac index were determined simultaneously before and after phenylephrine bolus and cardiac resynchronization therapy using 3-dimensional echocardiography-derived cardiac index as the reference method. Measurements and Main Results Cardiac index measured by the fourth-generation FloTrac/Vigileo had a wide limit of agreement with that measured by 3-dimensional echocardiography, with a percentage error of 59.1%. The tracking ability of the unit after both phenylephrine administration and cardiac resynchronization therapy were measured by concordance rate, and both were below the acceptable limit (72.7% and 85%, respectively). Conclusions The degree of accuracy of the fourth-generation FloTrac/Vigileo in patients with low cardiac index was not acceptable, and high systemic vascular resistance in patients with low cardiac index may have contributed to this inaccuracy. The tracking ability of the fourth-generation FloTrac/Vigileo after phenylephrine administration or cardiac resynchronization therapy was below acceptable limits. [ABSTRACT FROM AUTHOR]

Objectives First, to examine the perioperative association between increased cardiac index (CI) measured using three-dimensional echocardiography (CI 3D ), two-dimensional echocardiography (CI 2D ), and FloTrac/Vigileo (CI FT ) (Edwards Lifesciences, Irvine, CA) after cardiac resynchronization therapy (CRT) and decreased brain natriuretic peptide (BNP) 6 months after CRT. Second, to evaluate the accuracy and tracking ability of CI 2D and CI FT . Design A prospective clinical study. Setting A cardiac surgery operating room in a single cardiovascular center. Participants Forty-five patients undergoing elective CRT lead implantation. Interventions CI FT and CI 2D were determined simultaneously before and after CRT using CI 3D as the reference method. Measurements and Main Results BNP was measured before CRT and 6 months after CRT. Areas under the receiver operator characteristic curves (AUCs) were calculated for each method of measurement to predict BNP decrease. AUC was largest for CI 3D (AUC = 0.735, p = 0.017). Bland-Altman analysis revealed that the percentage error was 58% for CI FT and 28% for CI 2D. A polar plot analysis showed that the mean angular bias was -7.26° and 0.64°, the radial limits of agreement were 70° and 29.4°, and the concordance rate was 67.7% and 93.8% for CI FT and CI 2D, respectively. Conclusions CI significantly increased after CRT in patients whose BNP level decreased 6 months after CRT. However, only CI 3D could predict decreases in BNP 6 months after CRT. Although CI 2D was acceptable compared with CI 3D , the tracking ability of CI changes was just below acceptable. CI FT has a wide limit of agreement with CI 3D, with a poor tracking ability. [ABSTRACT FROM AUTHOR]

Objective Postoperative respiratory complications are serious and frequently observed among patients who undergo thoracoabdominal aortic aneurysm (TAAA) repair. Paravertebral block (PVB) can provide effective analgesia for relief of postoperative thoracotomy pain and may reduce respiratory complications. However, the impact of PVB on postoperative pain and respiratory function in patients who undergo TAAA repair requiring intraoperative high-dose heparin administration is unknown. This study examined the efficacy of PVB on postoperative pain and respiratory function after TAAA repairs. Design Retrospective, observational cohort study. Setting Single center in Japan. Participants Fifty-eight consecutive patients who underwent TAAA repair from March 2013 to October 2014. Interventions Application of thoracic PVB. Measurement and Main Results A total of 56 patients were analyzed. Two patients were excluded because 1 patient was dead within 24 hours after surgery and 1 patient was 9 years old. Patients with PVB were defined as group P (n = 17), and patients without PVB as group C (n = 39). There was no significant difference in baseline characteristics between the 2 groups. Both postoperative pain at rest and postoperative pain while coughing were assessed using a numeric rating scale (NRS); the incidence of reintubation and noninvasive positive-pressure ventilation (NPPV) also were compared between the 2 groups. The NRS score of postoperative pain at rest was significantly lower in group P (group P: Median 2, interquartile range 1 to 3; group C: Median 6, interquartile range 5 to 7; p = 0.000), and the NRS score of postoperative pain while coughing was significantly lower in group P (group P: Median 5, interquartile range 3.5 to 6.5; group C: Median 8, interquartile range 7 to 10; p = 0.000). Reintubation rate was significantly lower in group P (group P: 0%, group C: 23%, p = 0.045); the incidences of NPPV (group P: 12%, group C: 46%, p = 0.016) and postoperative pneumonia were significantly lower in group P (group P: 0%, group C: 28%, p = 0.024). Conclusions PVB significantly reduced postoperative pain at rest and while coughing and significantly reduced the reintubation rate, the rate of NPPV use, and postoperative pneumonia without complications. PVB could be a safe and an effective analgesic method that reduces postoperative respiratory exacerbation in patients who undergo TAAA repair. [ABSTRACT FROM AUTHOR]

Objectives The goal of this study was to compare cardiac output derived from the FloTrac/Vigileo™ system (CO FT ) with cardiac output measured by 3-dimensional transesophageal echocardiography (CO 3D ) in patients with severe heart failure undergoing cardiac resynchronization therapy. The impact of preoperative systemic vascular resistance index on the accuracy of the FloTrac/Vigileo™ system also was investigated. Design Prospective clinical study. Setting Cardiac surgery operating room of a single cardiovascular center. Participants Forty-one patients undergoing elective cardiac resynchronization therapy lead implantation. Interventions CO 3D as the reference method and CO FT were determined simultaneously after induction of anesthesia. Measurements and Main Results Linear regression analysis showed a poor correlation between CO 3D and CO FT (R² = 0.16). Bland–Altman plots showed wide limits of agreement between CO 3D and CO FT. . Bias was 0.60±0.63 L/min with a high percentage error of 58.2%. Subgroup analysis showed that the percentage error between CO 3D and CO FT was 74.1% in patients with a cardiac index<2.2 L/min/m 2 and 17.2% in patients with a cardiac index≥2.2 L/min/m 2 . Systemic vascular resistance index was significantly higher in patients with a cardiac index<2.2 L/min/m 2 (3,037±820 v 2,461±878; p = 0.039). Conclusions The FloTrac/Vigileo™ system is not accurate in patients with low cardiac output, especially those with a cardiac index<2.2 L/min/m 2 . A high systemic vascular resistance index in patients with low cardiac index may contribute to this inaccuracy. [ABSTRACT FROM AUTHOR]

Objective: To compare cardiac output (CO) measurements acquired using the Flotrac/Vigileo system (Edwards Lifesciences, Irvine, CA) and CO measured by transesophageal echocardiography using the product of the aortic valve area, the time integral of flow at the same site, and the heart rate during abdominal aortic aneurysm (AAA) surgery. Design: A prospective clinical study. Setting: Cardiac surgery operating room of 1 heart center hospital. Participants: Twenty patients undergoing elective AAA surgery. Interventions: CO was determined simultaneously using the Flotrac/Vigileo system (COAP) and transesophageal echocardiography (COTEE) as the reference method at 8 time points during AAA surgery. Measurements and Main Results: One hundred sixty simultaneous datasets were obtained. The authors observed a significant correlation between COAP and COTEE values (R = 0.56, p < 0.001). Bland-Altman analysis of COAP and COTEE showed a bias of 0.12 L/min and limits of agreement from −1.66 to 1.90 L/min, with a percentage error of 41%. Just after aortic clamping, COAP significantly increased, but COTEE decreased in comparison with previous measurements. There was a significant association among changes in COAP and pulse pressure, heart rate, and central venous pressure (CVP). However, changes in COTEE were only associated with variations in heart rate. Conclusions: COAP values were not clinically acceptable for use in AAA surgery because of wide variations during aortic clamping and declamping. Changes in pulse pressure, heart rate, and CVP were associated with significant changes in COAP, whereas only changes in heart rate showed associated changes in COTEE. [ABSTRACT FROM AUTHOR]