Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
J Cardiothorac Vasc Anesth. 2020 May;34(5):1220-1225. doi: 10.1053/j.jvca.2019.09.023. Epub 2019 Sep 27.
This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population.
This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019.
Weill Cornell Medicine, a single large academic medical center.
The study comprised 119 patients undergoing elective cardiac surgery.
Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery.
Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (<35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]).
PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.
本研究旨在评估体外循环（CPB）前后肺动脉搏动指数（PAPi）是否可预测和诊断择期心脏手术患者新发右心室（RV）衰竭。
这是一项对 2017 年至 2019 年期间接受心脏手术的患者进行的前瞻性观察研究。
纽约西奈山伊坎医学院，一个大型学术医疗中心。
该研究纳入 119 例行择期心脏手术的患者。
CPB、经食管超声心动图、肺动脉导管和择期心脏手术。
在 2 个时间点采集超声心动图和血流动力学数据：CPB 前和胸部闭合/CPB 后。比较 CPB 后 RV 功能障碍（<35%）患者与无 RV 功能障碍患者，绘制受试者工作特征曲线。对 119 例行择期手术的患者（冠状动脉旁路移植术 23%、主动脉瓣置换术 21%、主动脉手术 19%、联合手术 37%）进行评估。CPB 后 RV 功能障碍与较低的 CPB 前 PAPi 值（2.0 ± 1.0 比 2.5 ± 1.2；p = 0.001 和 p = 0.03）和较高的 CPB 前中心静脉压（8.3 ± 3.6 和 6.9 ± 2.7；p = 0.003 和 p = 0.02）相关。CPB 前 PAPi（0.98 [95%置信区间 {CI} 0.96-0.99]）、收缩末期面积（0.99 [95% CI 0.98-0.99]）和舒张末期面积（1.01 [95% CI 1.001-1.02]）在多变量模型中与 RV 功能障碍独立相关，较低的 PAPi 和收缩末期面积以及较高的舒张末期面积提示 CPB 后 RV 功能障碍风险更高（CPB 后 PAPi 曲线下面积为 0.80 [95% CI 0.71-0.88；敏感性 = 0.68，特异性 = 0.93，最佳截断值 = 1.9]）。
CPB 前测量的 PAPi 是 CPB 后 RV 功能障碍的潜在预测因子和标志物，在心脏手术中可能具有诊断价值。需要进一步开展更大规模的研究来证实这一发现。
