[Reduction in the use of pulmonary artery catheter for cardiovascular surgery]

In this study we have surveyed the rate of use of pulmonary artery catheter (PAC) in 319 cardiovascular operations from 1997 to 2001. The rate was decreasing year by year from 100%(6/6) in 1997, 77%(39/51) in '98, 32%(24/75) in '99, 20%(19/93) in 2000, to 8.5%(8/94) in 2001. Especially in elective coronary artery bypass grafting (CABG), an extreme reduction was found: 100%(3/3), 95% (19/20), 17%(6/35), 2.2%(1/45), 0%(0/53), respectively. There was no statistical significance between the use and hospital mortality. We consider that this reduction is due to improvement of the surgical technique and anesthetic management. As transesophageal echocardiography (TEE) has improved anesthetic management of the cardiac patients, we have employed it for all cases. We are sure that TEE contributed to the reduction in the catheter use. Cardiac functions monitored with PAC can be largely substituted with TEE except mixed venous oxygen saturation, but it is not continuous monitoring. Current indications of PAC is for patients with pulmonary hypertension and low cardiac output, as well as those who are predicted to be difficult for postoperative management, and those who have off pump CABG with inverted heart position, at our institution. Routine use of PAC for cardiac surgery should be reconsidered.