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Transpulmonary versus continuous thermodilution cardiac output after valvular and coronary artery surgery

^a Department of Intensive Care and Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
^b Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands

*Corresponding author. Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Tel.: +31-20-4444178; fax: +31-20-4442392.

E-mail address: johan.groeneveld{at}vumc.nl (A.B.J. Groeneveld).

Residual left-sided valvular insufficiencies after valvular surgery may confound transpulmonary thermodilution cardiac output (COtp). We compared the technique with the continuous right-sided thermodilution technique (CCO) after valvular surgery (n=8) and coronary artery surgery (n=8). Patients with pulmonary and femoral artery catheters in the intensive care unit (ICU) were included. After valvular surgery, there was minimal aortic insufficiency in four patients and minimal to moderate mitral valve insufficiency in six. Five fluid loading steps (250 ml) were done in each patient. CCO and COtp were measured prior to and 15 min after each step. The cardiac output was lower after valvular than coronary artery surgery but responses to fluid loading steps were similar among surgery types and techniques. After valvular and coronary artery surgery, cardiac output was lower prior to responses than in non-responses to fluids, by either technique. After valvular surgery, COtp and CCO correlated (r=0.64, P<0.001, n=48) but fluid-induced changes did not. After coronary artery surgery, COtp and CCO correlated (r=0.81, P<0.001) and changes also did (r=0.55, P<0.001). At fluid-induced CCO increases <20%, the r for changes in cardiac output measured by both techniques was similar after valvular and coronary artery surgery. Thus, COtp and CCO were of similar value in predicting and monitoring fluid responses after both surgery types. This argues against left-sided valvular insufficiencies confounding COtp.

Key Words: Cardiac function; Heart valve; Hemodynamics; Mitral valve repair; Shock (circulatory)