Cristina Giglioli1, Emanuele Cecchi1, Pier Luigi Stefàno2, Valentina Spini1, Giacomo Fortini1, Marco Chiostri3, Niccolò Marchionni1,3, Salvatore Mario Romano1,3. 1. Division of General Cardiology, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 2. Division of Cardiosurgery, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 3. Department of Experimental and Clinical Medicine, Unit of Internal Medicine and Cardiology, University of Florence, Florence, Italy.
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.
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.
Authors: Cristina Giglioli; Martina Nesti; Emanuele Cecchi; Daniele Landi; Marco Chiostri; Gian Franco Gensini; Valentina Spini; Salvatore Mario Romano Journal: Int J Cardiol Date: 2013-07-24 Impact factor: 4.164
Authors: Alessandro Parolari; Lorenzo L Pesce; Matteo Trezzi; Laura Cavallotti; Samer Kassem; Claudia Loardi; Davide Pacini; Elena Tremoli; Francesco Alamanni Journal: Ann Thorac Surg Date: 2010-03 Impact factor: 4.330
Authors: Melanie L Bell; Gary K Grunwald; Janet H Baltz; Gerald O McDonald; Missy R Bell; Frederick L Grover; A Laurie W Shroyer Journal: Ann Thorac Surg Date: 2008-11 Impact factor: 4.330
Authors: David M Shahian; Sean M O'Brien; Giovanni Filardo; Victor A Ferraris; Constance K Haan; Jeffrey B Rich; Sharon-Lise T Normand; Elizabeth R DeLong; Cynthia M Shewan; Rachel S Dokholyan; Eric D Peterson; Fred H Edwards; Richard P Anderson Journal: Ann Thorac Surg Date: 2009-07 Impact factor: 4.330