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Coronary Perfusion Pressure during Antegrade Cardioplegia in On-Pump CABG Patients
Jackson Brandão Lopes1, Carlos Cezar Monteiro Dos Santos1
1Faculdade de Medicina da Bahia da Universidade Federal da Bahia (FMB-UFBA), Salvador, BA, Brazil.
Insights
Palpation and cardioplegia line pressure are inaccurate for estimating aortic tension during cardiac surgery. Direct intraluminal pressure measurement is essential for safe cardioplegia delivery, with other methods serving only as complements.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Perfusion Technology
Background:
- Accurate monitoring of aortic pressure during cardioplegia infusion is crucial for patient safety in coronary artery bypass graft (CABG) surgeries.
- Current methods for estimating aortic tension include surgeon palpation and monitoring cardioplegia infusion line pressure.
Purpose of the Study:
- To evaluate the equivalence of aortic tension estimation by palpation and cardioplegia infusion line pressure compared to direct aortic intraluminal pressure measurement.
- To determine the reliability of non-invasive methods in guiding cardioplegia delivery during cardiac procedures.
Main Methods:
- Sixty patients undergoing CABG with extracorporeal circulation were studied.
- Aortic root pressure was estimated by surgeon palpation and cardioplegia infusion line pressure.
- Direct aortic intraluminal pressure was measured concurrently by an anesthesiologist.
Main Results:
- The Bland-Altman analysis revealed significant variation between palpation and intraluminal pressure measurements (bias: -9.911±18.75%).
- A weak correlation was found between intraluminal pressure and cardioplegia line pressure (Spearman's r=0.61, P<0.0001).
- Palpation and cardioplegia line pressure were identified as inaccurate methods for assessing aortic tension.
Conclusions:
- Direct measurement of aortic intraluminal pressure is the gold standard for controlling cardioplegia infusion.
- Palpation and cardioplegia line pressure should not be relied upon as primary methods for monitoring aortic tension.
- These less accurate methods may serve as complementary tools to enhance safety within the cardioplegia circuit.
Objective::
The aim of this study was to investigate whether aortic tension estimated by palpation and cardioplegia infusion line pressure provide results equivalent to those obtained with direct aortic intraluminal pressure measurement.
Methods::
Sixty consecutive patients who underwent coronary artery bypass graft surgeries with extracorporeal circulation were analyzed. Sanguineous cardioplegic solution in a ratio of 4:1 was administered using a triple lumen antegrade cannula. After crossclamping, cardioplegia was infused and aortic root pressure was recorded by surgeon (A) considering the aortic tension he felt in his fingertips. At the same time, another surgeon (B) recorded his results for the same measurement. Concomitantly, the anesthesiologist recorded intraluminal pressure in the aortic root and the perfusionist recorded delta pressure in cardioplegia infusion line. None of the participants involved in these measurements was allowed to be informed about the values provided by the other examiners.
Results::
The Bland-Altman test showed that a considerable variation between aortic wall tension was found as measured by palpation and by intraluminal pressure, with a bias of -9.911±18.75% (95% limits of agreement: -46.7 to 26.9). No strong correlation was observed between intraluminal pressure and cardioplegia line pressure (Spearman's r=0.61, 95% confidence interval 0.5-0.7; P<0.0001).
Conclusion::
These findings reinforce that cardioplegia infusion should be controlled by measuring intraluminal pressure, and that palpation and cardioplegia line pressure are inaccurate methods, the latter should always be used to complement intraluminal measurement to ensure greater safety in handling the cardioplegia circuit.
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