Vincent Bouchard-Dechêne1, Pierre Couture1, Antonio Su2, Alain Deschamps1, Yoan Lamarche3, Georges Desjardins1, Sylvie Levesque4, André Y Denault5. 1. Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. 2. Department of Anesthesiology, Hôpital Cité de la Santé de Laval, Université de Montréal, Montreal, Quebec, Canada. 3. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Surgery, Division of Cardiovascular Critical Care, Montreal Heart Institute, Montreal, Quebec, Canada. 4. Montreal Health Innovations Coordinating Centre, Montreal Heart Institute, Montreal, Quebec, Canada. 5. Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Surgery, Division of Cardiovascular Critical Care, Montreal Heart Institute, Montreal, Quebec, Canada. Electronic address: andre.denault@gmail.com.
Abstract
OBJECTIVE: To identify risk factors associated with radial-to-femoral pressure gradient during cardiac surgery with cardiopulmonary bypass (CPB). DESIGN: This is a retrospective, observational study. SETTING: Single specialized cardiothoracic hospital in Montreal, Canada. PARTICIPANTS: Consecutive patients that underwent heart surgery with CPB between 2005 and 2015 (n = 435). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A radial-to-femoral pressure gradient occurred in 146 patients of the 435 patients (34%). Based on the 10,000 bootstrap samples, simple logistic regression models identified the 17 most commonly significant variables across the bootstrap runs. Using these variables, a backward multiple logistic model was performed on the original sample and identified the following independent variables: body surface area (m2) (odds ratio [OR] 0.08, 95% confidence interval [CI] 0.030-0.232), clamping time (minutes) (OR 1.01, 95% CI 1.007-1.018), fluid balance (for 1 liter) (OR 0.81, 95% CI 0.669-0.976), and preoperative hypertension (OR 1.801, 95% CI 1.131-2.868). CONCLUSION: A radial-to-femoral pressure gradient occurs in 34% of patients during cardiac surgery. Patients at risk seem to be of smaller stature, hypertensive, and undergo longer and more complex surgeries.
OBJECTIVE: To identify risk factors associated with radial-to-femoral pressure gradient during cardiac surgery with cardiopulmonary bypass (CPB). DESIGN: This is a retrospective, observational study. SETTING: Single specialized cardiothoracic hospital in Montreal, Canada. PARTICIPANTS: Consecutive patients that underwent heart surgery with CPB between 2005 and 2015 (n = 435). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A radial-to-femoral pressure gradient occurred in 146 patients of the 435 patients (34%). Based on the 10,000 bootstrap samples, simple logistic regression models identified the 17 most commonly significant variables across the bootstrap runs. Using these variables, a backward multiple logistic model was performed on the original sample and identified the following independent variables: body surface area (m2) (odds ratio [OR] 0.08, 95% confidence interval [CI] 0.030-0.232), clamping time (minutes) (OR 1.01, 95% CI 1.007-1.018), fluid balance (for 1 liter) (OR 0.81, 95% CI 0.669-0.976), and preoperative hypertension (OR 1.801, 95% CI 1.131-2.868). CONCLUSION: A radial-to-femoral pressure gradient occurs in 34% of patients during cardiac surgery. Patients at risk seem to be of smaller stature, hypertensive, and undergo longer and more complex surgeries.
Authors: Vincent Bouchard-Dechêne; Loay Kontar; Pierre Couture; Philippe Pérusse; Sylvie Levesque; Yoan Lamarche; André Y Denault Journal: JTCVS Open Date: 2021-08-05