Open AccessUsefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery
Author(s) -
Jungwon Kim,
JiYeon Bang,
Chun Soo Park,
Mijeung Gwak,
Won-Jung Shin,
GyuSam Hwang
Publication year - 2016
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000005405
Subject(s) - medicine , cardiopulmonary bypass , peripheral , weaning , cardiology , great arteries , heart rate , heart defect , blood pressure , anesthesia , heart disease
The maximum rate of pressure rise (dP/dt max ) in radial artery has been proposed as a noninvasive surrogate of aortic dp/dt max , reflecting left ventricular (LV) contractility in children. The aim of this study was to investigate relationship between aortic and radial dp/dt max at weaning from cardiopulmonary bypass (CPB) and usefulness of these indices for estimating postoperative outcomes in pediatric congenital heart surgery. Aortic and radial arterial pressure waveforms were analyzed simultaneously during weaning from CPB in 29 congenital heart surgery. The maximum first derivatives of aortic and radial arterial waveforms were calculated and averaged from 3 consecutive respiratory cycles. We obtained the maximum vasoactive inotropic score during the first 36 postoperative hours, LV ejection fraction, and fractional shortening on transthoracic echocardiography performed within postoperative day 7. A significant difference between aortic and radial dP/dt max was observed (mean difference 356 mm Hg/s, 44% of averages), and radial dP/dt max was weakly correlated with aortic dP/dt max ( r =0.373, P = 0.047). Aortic dP/dt max was significantly associated with the maximum vasoactive inotropic score ( P < 0.001), postoperative LV ejection fraction ( P = 0.018), and fractional shortening ( P = 0.015); however, radial dP/dt max was not. On Receiver operating characteristic analysis, aortic dP/dt max had a greater area under the curve than radial dP/dt max in predicting higher vasoactive inotropic score (0.827 vs 0.673). Immediately after CPB in pediatric congenital heart surgery, radial dP/dt max may not replace aortic dP/dt max because of a discrepancy between central and peripheral arterial waveforms. In this critical period, aortic dP/dt max can be useful to estimate postoperative ventricular function rather than peripherally derived dP/dt max .