Comparison of Cardiac Output of Both 2 and 3 Dimensional Transoesophageal Echocardiography With Transpulmonary Thermodilution During Cardiac Surgery

Abstract The aim of this review is to present the current options for cardiac output (CO) monitoring in children undergoing cardiac surgery. Current technologies for monitoring identified were a range of invasive, minimally invasive, and non-invasive technologies. These include pulmonary artery catheter, transoesophageal echocardiography, pulse contour analysis, electrical cardiography, and thoracic bioreactance. A literature search was conducted using evidence databases which identified two current guidelines; the NHS Greater Glasgow and Clyde guideline and Royal College of Anaesthetics Guideline. These were appraised using the AGREE II tool and the evidence identified was used to create an overview summary of each technological option for CO monitoring. There is limited evidence regarding the accuracy of modalities available for CO monitoring in paediatric patients during cardiac surgery. Each technology has advantages and disadvantages; however, none could be championed as the most beneficial. Furthermore, a gold standard for CO monitoring has not yet been identified for paediatric populations, nor is it apparent whether one modality is preferable based on the available evidence. Additional evidence using a standardised method for comparing CO measurements should be conducted in order to determine the best option for CO monitoring in paediatrics. Furthermore, cost-effectiveness assessment of each modality should be conducted. Only then will it be possible for clear, evidence-based guidance to be written.

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Transoesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with thermodilution*

Anaesthesia ◽

10.1111/j.1365-2044.2004.03928.x ◽

2004 ◽

Vol 59 (12) ◽

pp. 1184-1192 ◽

Cited By ~ 32

Author(s):

D. A. Bettex ◽

V. Hinselmann ◽

J. P. Hellermann ◽

R. Jenni ◽

E. R. Schmid

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Transoesophageal Echocardiography

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Risk factors for poor outcome after ECMO treatment of low cardiac output after cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967647 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

S Deiters ◽

H Welp ◽

J Graf ◽

A Löher ◽

S Schneider ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Output ◽

Cardiac Surgery ◽

Low Cardiac Output ◽

Poor Outcome ◽

Ecmo Treatment

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Blood gas analysis in newborns with low cardiac output syndrome after cardiac surgery.

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2018-19-5-676-687 ◽

2018 ◽

Vol 19 (5) ◽

pp. 676-687

Author(s):

G.G. Khubulava ◽

A.B. Naumov ◽

S.P. Marchenko ◽

O.Yu. Chupaeva ◽

A.A. Seliverstova ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

Annals of Intensive Care ◽

10.1186/s13613-021-00808-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Rafael Alves Franco ◽

Juliano Pinheiro de Almeida ◽

Giovanni Landoni ◽

Thomas W. L. Scheeren ◽

Filomena Regina Barbosa Gomes Galas ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Prolonged Mechanical Ventilation ◽

Kidney Injury ◽

Composite Endpoint ◽

Tissue Perfusion ◽

Hospital Length Of Stay ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output ◽

Noninferiority Trial

Abstract Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

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Utility of 3-dimensional transoesophageal echocardiography for mitral annular sizing in transcatheter mitral valve replacement procedures: a cardiac computed tomography comparative study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.212 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Coisne ◽

F Pontana ◽

S Aghezzaf ◽

S Mouton ◽

H Ridon ◽

...

Keyword(s):

Computed Tomography ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Cardiac Computed Tomography ◽

Transoesophageal Echocardiography ◽

3 Dimensional ◽

Ct Measurements ◽

Good Ability ◽

Transcatheter Mitral Valve Replacement

Abstract Funding Acknowledgements Type of funding sources: None. Background. 3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening. Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT. Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p < 0.0001). Correlations were significant but lower for MA diameters (r = 0.68 to 0.72, p < 0.0001) and mitro-aortic angle (r = 0.53, p = 0.0001). ROC curve analyses showed that 3D-TEE had a good ability to predict TMVR screening success defined by constructors based on CT measurements with a range of 12.9 to 15cm² for MA area (AUC = 0.88-0.91, p < 0.0001), 128 to 139mm for MA perimeter (AUC = 0.85-0.91, p < 0.0001), 35 to 39mm for anteroposterior diameter (AUC = 0.79-0.84 p < 0.0001) and 37 to 42mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, p < 0.0001) (Figure 1). Conclusion. 3D-TEE measurements of MA dimensions display strong correlation with CT measurements in patients undergoing TMVR screening process. 3D-TEE should be proposed as a reasonable alternative to CT in this vulnerable population. Abstract Figure.

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