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A Descriptive Study of Perioperative Hemodynamics in Open Cardiac Surgery Patients
Hjördis Osk Atladottir1, Jacob Greisen1, Carl-Johan Jakobsen1
1Department of Cardiothoracic and Vascular Surgery and Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Older patients undergoing cardiac surgery show lower cardiac index and mixed venous oxygen saturation. Poorer postoperative hemodynamics increase mortality risk, especially in older individuals or those needing inotropic agents.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Cardiac surgery patients require careful hemodynamic monitoring.
- Age significantly impacts physiological responses to surgery and recovery.
Purpose of the Study:
- To investigate how age influences perioperative hemodynamic profiles in cardiac surgery.
- To determine the association between postoperative hemodynamics and one-year mortality.
Main Methods:
- Retrospective analysis of 6,595 elective on-pump cardiac surgery patients (2006-2016).
- Hemodynamic data (mean arterial pressure, cardiac index, mixed venous oxygen saturation) extracted from anesthesia and ICU records.
- Logistic regression used to assess one-year mortality risk based on postoperative hemodynamics, stratified by age and inotropic agent use.
Main Results:
- Increasing age correlated with lower cardiac index and mixed venous oxygen saturation throughout the perioperative period.
- Lower postoperative hemodynamic values were associated with a higher probability of one-year mortality.
- The impact of hemodynamics on mortality was modified by patient age and the requirement for inotropic support.
Conclusions:
- Age influences perioperative hemodynamics in cardiac surgery patients.
- Postoperative hemodynamic status is a significant predictor of one-year mortality, with age and inotropic support as modifying factors.
Objectives:
The purpose of the present study was to describe how the perioperative hemodynamic profile before and after cardiopulmonary bypass during cardiac surgery is influenced by age and to describe the association between postoperative hemodynamics and one-year mortality.
Design:
A retrospective registry-based study.
Setting:
University Hospital of Aarhus, Denmark.
Participants:
The study comprised 6,595 patients undergoing elective on-pump cardiac surgery from 2006 to 2016.
Measurements And Main Results:
Perioperative hemodynamic values were derived from computerized anesthesia and intensive care reports, including mean arterial pressure, cardiac index, and oxygenation saturation from mixed venous blood in the pulmonary artery, during the perioperative period. Perioperative hemodynamic values were stratified according to age. Logistic regression was applied to predict the crude probability of death within one year from surgery according to hemodynamic values at six hours after surgery, stratified by age and use of inotropic agents, respectively. Lower values for cardiac index and mixed venous blood in the pulmonary artery with increasing age, across all points in time in the perioperative course, were observed. Higher probability of death was associated with lower hemodynamic values in the postoperative phase, and the probability of death was modified by age and the need for inotropic agents.
Discussion:
This is a large registry based study describing the perioperative hemodynamic profile of patients undergoing cardiac surgery and the results enhance our understanding of age-differentiated values of CI and SvO2 in this specific population.
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