Cytoreductive surgery for advanced ovarian cancer: cardiovascular evaluation with pulmonary artery catheters

Twenty-three patients underwent pulmonary artery (Swan-Ganz) catheterization for hemodynamic monitoring immediately after cytoreductive surgery for advanced ovarian cancer. Seventeen patients were studied continuously for at least 24 hr to determine the postoperative hemodynamic changes; 6 patients were intermittently monitored. The mean age was 63 years, mean operating time was 4.4 hr, mean ascites volume was 2300 ml, and estimated mean blood loss was 1300 ml. The mean nadir arterial pressure was 90 mm Hg at 6 hr, rising to a maximum of 105 mm Hg at 18 hr. The mean right atrial pressure was 2.6 mm Hg at 6 hr and 7.5 mm Hg at 24 hr; and mean pulmonary capillary wedge pressure nadir was 7.3 mm Hg at 6 hr and 10.7 mm Hg at 24 hr. The systemic vascular resistance zenith was 1400 dyne/sec/cm-5 at 6 hr and 860 dyne/sec/cm-5 at 24 hr. The monitoring technique permitted the early identification of myocardial infarction in two patients, both of whom had increased systemic vascular resistance and pulmonary capillary wedge pressure, and required dopamine to maintain arterial pressure. One patient had a pulmonary embolus, reflected by an increased right atrial pressure, decreased cardiac output, and normal pulmonary capillary wedge pressure. In all three instances, pulmonary artery catheterization facilitated prompt, early diagnosis of cardiovascular compromise and permitted early therapeutic intervention. These data document that rapid and extreme changes in the cardiovascular system occur in patients undergoing cytoreductive surgery. These changes include a rapid increase in systemic vascular resistance, a decrease in pulmonary capillary wedge pressure, a reflex tachycardia, and a decrease in cardiac output; all of these changes result from an acute shift of intravascular volume to the extracellular space and a relative hypovolemia requiring active resuscitation. Pulmonary artery catheterization plays an important role in monitoring these hemodynamic changes and a predictable uniform recovery with fluid resuscitation.