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Submitted: 31 Aug 2020
Revision: 12 Oct 2020
Accepted: 02 Nov 2020
ePublished: 13 Dec 2020
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J Cardiovasc Thorac Res. 2020;12(4): 313-320.
doi: 10.34172/jcvtr.2020.62
  Abstract View: 41
  PDF Download: 43

Original Article

Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery

Cristina Giglioli* ORCID logo, Emanuele Cecchi, Pier Luigi Stefàno, Valentina Spini, Giacomo Fortini, Marco Chiostri, Niccolò Marchionni, Salvatore Mario Romano

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.
Keywords: Cardiac-Surgery, Hemodynamic Profile, Clinical Six Months Follow-up
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