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Published on: February 26, 2013
Routine left atrial catheterization for the post-operative management of cardiac surgical patients: is the risk
F Santini1, G Gatti, V Borghetti
1Division of Cardiac Surgery, University of Verona Medical School, OCM Borgo Trento, Italy. fsant@yahoo.com
Insights
Routine left atrial catheterization in cardiac surgery patients is safe and effective. Complications are rare (0.24%), with benefits like hemodynamic monitoring and drug delivery outweighing risks.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Medical Device Technology
Background:
- Post-operative management of cardiac surgery patients requires precise hemodynamic monitoring.
- Left atrial monitoring lines offer direct access to left atrial pressure, crucial for managing complex cardiac conditions.
Purpose of the Study:
- To evaluate the risk-benefit ratio, including cost, of routine left atrial catheterization in post-cardiac surgery patients.
- To determine the safety and efficacy of left atrial monitoring lines in this population.
Main Methods:
- A retrospective analysis of 5815 cardiac surgery patients who received left atrial monitoring lines between November 1991 and June 1998.
- Invasive insertion technique with catheter removal on postoperative days 1 or 2.
Main Results:
- A low complication rate of 0.24% (14 patients) was observed, including bleeding and catheter retention.
- No mortality was associated with left atrial line use.
- The line facilitated critical hemodynamic monitoring and served as a route for catecholamine infusion in select cases.
Conclusions:
- Complications associated with left atrial monitoring catheters in cardiac surgery are infrequent and acceptable.
- Meticulous management can further reduce complication rates.
- The diagnostic and therapeutic advantages of left atrial lines justify their use in post-cardiac surgery management.
Objective:
To assess the risk/benefit ratio, including cost, associated with routine left atrial catheterization for the post-operative management of patients after cardiac surgery.
Methods:
From November 1991 to June 1998, out of 6187 open heart procedures performed at our institution, 5815 patients (94%) receive a left atrial monitoring line inserted invasively by a unique and reproducible technique. Catheters were removed on the first or second postoperative day before chest tube removal. A subgroup of 385 patients (7%) were switched to a Swan-Ganz catheter postoperatively.
Results:
A total of 14 patients suffered a complication related to the left monitoring line (0.24%). Bleeding necessitating transfusion occurred in 10 patients (0.17%), seven of whom required surgical reexploration (0.12%). Catheter retention occurred in four cases (0.07%), requiring a mediastinal reexploration in one and a minimally invasive procedures in three, for removal. No other complications related to the presence of a left atrial line emerged in this series. Apart from providing crucial hemodynamic information on a routine basis, in nine selected patients (0.15%) in a low cardiac output state with increased pulmonary vascular resistance and right ventricular failure, the left atrial line was used as a preferential route for catecholamine infusion, with significant hemodynamic improvement.
Conclusions:
Complications of left atrial monitoring catheters in cardiac surgery do occur but at a very low and acceptable rate. No mortality was correlated to their use in our series. Complication rate can be further lowered by a meticulous management of the device. The wealth of information and therapeutic options offered by this line appears to outweigh the associated risk.
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