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Marked mixed venous desaturation during early mobilization after aortic valve surgery
Idar Kirkeby-Garstad1, Olav F M Sellevold, Roar Stenseth
1*Section of Cardiothoracic Anesthesia and the †Department of Cardiothoracic Surgery, St. Elisabeth Heart Center, University Hospital of Trondheim, Trondheim, Norway, and the ‡Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Unlabelled:
We investigated the physiological reaction to mobilization the first and second day after aortic valve replacement in an open, prospective study. Hemodynamic and oxygenation variables were recorded in 15 patients using a pulmonary artery oximetry catheter and bench oximetry. Serious intraoperative events occurred in 3 patients, but all patients began mobilization on the first postoperative day and mobilization was accomplished without clinical problems. Mixed venous oxygen saturation (SvO(2)) at rest was 58.0 +/- 7.7% (mean +/- SD) on the first postoperative day and 58.0 +/- 6.2% on the second day (NS). During mobilization, oxygen consumption increased by 64 +/- 41% and 58 +/- 33% on the first and second days (P < 0.01; NS between days). No compensatory increase in cardiac index and oxygen delivery was seen. Oxygen extraction increased, resulting in SvO(2) values during exercise of 35.7 +/- 6.8% on the first day and 36.7 +/- 7.7% on the second day (P < 0.01; NS between days), whereas mixed venous oxygen partial pressure was 3.0 +/- 0.4 kPa on both days. The lowest recorded value for SvO(2) was 10%. The marked and consistent mixed venous desaturation during early mobilization has not been described before and the clinical consequences and underlying mechanism require further investigation.
Implications:
During early mobilization after aortic valve replacement, a marked and consistent reduction in mixed venous oxygen saturation to 35% and mixed venous oxygen partial pressure to 3 kPa was observed.