Extending the Use of the Pacing Pulmonary Artery Catheter for Safe Minimally Invasive Cardiac Surgery

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…Of particular concern during cardiac surgery is their reported association with severe hypotension after CPB (so-called vasoplegia syndrome) and postoperative renal dysfunction. 631,639 Although it has been postulated that these agents may protect against the development of postoperative AF, published studies have reached conflicting conclusions in this regard. 634, 636 The safety and efficacy of ACE inhibitors and ARBs after CABG in previously naïve low-to moderate-risk patients (ie, subjects without diabetes mellitus or renal insufficiency and with or without asymptomatic moderate LV systolic dysfunction) are uncertain; furthermore, ACE inhibitors and ARBs must be used with caution in these subjects.…”

“…The reported rates of PAC use range from Ͻ10% in a combined private-academic setting to Ͼ90% in patients in the Department of Veterans Affairs health system. 61,639,701,702,713 Aside from providing an indirect assessment of left atrial pressure and the presence and severity of pulmonary hypertension, PAC can be used to measure cardiac output (by thermodilution) and to monitor the mixed venous oxygen saturation-information that may be helpful in the management of high-risk patients. 712, 714 The need for careful consideration of baseline patient risk, the planned procedure, and the patient setting before use of a PAC are outlined in several opinion pieces, consensus documents, the "Practice Guidelines for Pulmonary Artery Catheterization: An Updated Report by the American Society of Anesthesiologists," and the "2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery."…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…Nonetheless, the safety and effectiveness of preoperative ACE inhibitors and ARBs in patients undergoing cardiac or noncardiac surgery is uncertain (638) because their administration has been associated with intraoperative hypotension as well as a blunted response to pressors and inotropic agents after induction of anesthesia. Of particular concern during cardiac surgery is their reported association with severe hypotension after CPB (so-called vasoplegia syndrome) and postoperative renal dysfunction (631,639).…”

“…In fact, it has even been suggested that patients in whom a PAC is placed incur greater resource utilization and more aggressive therapy, which may lead to worse outcomes and higher costs. The reported rates of PAC use range from Ͻ10% in a combined private-academic setting to Ͼ90% in patients in the Department of Veterans Affairs health system (61,639,701,702,713).…”

Anesthetic Considerations During Minimally Invasive Mitral Valve Surgery

“…Fibrillation can be achieved either by a fibrillator applied directly to the heart or through the use of a pacing PAC. 41 …”