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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]

Purpose: The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CIFT) with that measured by three-dimensional echocardiography (CI3D).Methods: Twenty-six patients undergoing elective AAA surgery were included in this study. CIFT and CI3D were determined simultaneously in eight points including before and after aortic clamp. We used CI3D as the reference method.Results: In the Bland-Altman analysis, CIFT had a wide limit of agreement with CI3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO3D and COFT was 56.3% in patients with cardiac index < 2.5 L/min/m2 and 28.4% in patients with cardiac index ≥ 2.5 L/min/m2. SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m2 (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%).Conclusions: The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit. [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: 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]

We report an emergent case of cardiac tamponade due to rupture of the left ventricle. Preload and intracardiac volume were decreased by percutaneous cardiopulmonary support (PCPS), which led to the collapse of the cardiac chamber. The collapsed cardiac chamber made it difficult to diagnose cardiac abnormalities by preoperative transthoracic echocardiography (TTE). On loading fluid infusion and transfusion as volume load to improve the hemodynamic status, transesophageal echocardiography (TEE) revealed several leakages in the left ventricular myocardium. Continuous careful observation on TEE led us to a confident diagnosis of left ventricular rupture. The diagnosis by TEE also led to the employment of the appropriate procedure. TEE is useful for detecting an abnormality due to the location of the cardiac chamber and echocardiographic probe. We also note that continuous careful observation led to the employment of the appropriate procedure. [ABSTRACT FROM AUTHOR]