PMID- 20099696
OWN - NLM
STAT- MEDLINE
DCOM- 20100302
LR  - 20100126
IS  - 0966-8519 (Print)
IS  - 0966-8519 (Linking)
VI  - 18
IP  - 5
DP  - 2009 Sep
TI  - Predictors of ineffectual radial arterial pressure monitoring in valvular heart 
      surgery.
PG  - 546-53
AB  - BACKGROUND AND AIM OF THE STUDY: Unexpected sustained underestimation of the 
      central aortic pressure by the radial arterial pressure commonly develops 
      following cardiopulmonary bypass (CPB) in valvular heart surgery (VHS), leading 
      to an inappropriate use of vasopressors. The study aim was to identify clinical 
      predictors leading to a sustained inappropriate difference between the radial and 
      femoral arterial pressure (IDRF) in VHS. METHODS: A total of 200 patients 
      undergoing VHS was studied prospectively. Those patients who developed sustained 
      IDRF (systolic IDRF > or =10 mmHg and/or mean IDRF > or =5 mmHg) from immediately 
      after discontinuation of CPB until the end of the surgery were compared with 
      patients who did not develop any IDRF. RESULTS: Data from seven patients who 
      required second aortic cross-clamping and re-CPB were excluded from the analysis; 
      thus, data from 193 patients were analyzed. In total, 53 patients (27.5%) 
      developed sustained IDRF, whereas 80 patients (41.4%) did not develop any IDRF. 
      In multivariate analysis, female gender, the presence of atrial fibrillation and 
      diuretic use were identified as independent preoperative predictors; 
      longer-duration aortic cross-clamping and use of larger amounts of vasopressin 
      during CPB were identified as independent operative risk factors of the sustained 
      IDRF. CONCLUSION: When an erroneously low radial arterial pressure is suspected 
      following CPB in this subset of patients undergoing VHS, monitoring of the 
      femoral or axillary arterial pressure should be considered to guide hemodynamic 
      management, as there is an increased risk of persistence of this phenomenon.
FAU - Hong, Seong Wook
AU  - Hong SW
AD  - Department of Anesthesiology and Pain Medicine, Yonsei University College of 
      Medicine, Seoul, South Korea.
FAU - Shim, Jae Kwang
AU  - Shim JK
FAU - Choi, Yong Seon
AU  - Choi YS
FAU - Chun, Duk-Hee
AU  - Chun DH
FAU - Kim, Jong Chan
AU  - Kim JC
FAU - Kim, Bum Su
AU  - Kim BS
FAU - Kwak, Young Lan
AU  - Kwak YL
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Heart Valve Dis
JT  - The Journal of heart valve disease
JID - 9312096
SB  - IM
MH  - Aged
MH  - Axillary Artery/physiology
MH  - Cardiopulmonary Bypass
MH  - Comorbidity
MH  - Female
MH  - Femoral Artery/physiology
MH  - Heart Valve Diseases/epidemiology/*physiopathology/*surgery
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - *Monitoring, Intraoperative
MH  - Prospective Studies
MH  - Radial Artery/*physiology
EDAT- 2010/01/27 06:00
MHDA- 2010/03/03 06:00
CRDT- 2010/01/27 06:00
PHST- 2010/01/27 06:00 [entrez]
PHST- 2010/01/27 06:00 [pubmed]
PHST- 2010/03/03 06:00 [medline]
PST - ppublish
SO  - J Heart Valve Dis. 2009 Sep;18(5):546-53.