Monitoring with two-dimensional transesophageal echocardiography

Roizen, Michael F.; Beaupre, Paul N.; Alpert, Ricki A.; Kremer, P.; Cahalan, Michael K.; Shiller, Nelson; Sohn, Young-Jong; Cronnelly, R.; Lurz, Francis W.; Ehrenfeld, William K.; Stoney, Ronald J.

doi:10.1016/0741-5214(84)90061-2

Cited by 179 publications

(4 citation statements)

References 17 publications

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“…Cardiac output is generally decreased by 9% to 33% [27]. Reported changes in ventricular filling pressures have been inconsistent [12, 27, 29]. Changes in these parameters seen in both groups, in the present study, followed a similar pattern.…”

Section: Discussionsupporting

confidence: 74%

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Martín-Cancho

Crisóstomo

Soria

et al. 2008

Anesthesiology Research and Practice

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The aim of this study was to compare the hemodynamic and ventilatory effects of prolonged infrarenal aortic cross-clamping in pigs undergoing either laparotomy or laparoscopy. 18 pigs were used for this study. Infrarenal aortic crossclamping was performed for 60 minutes in groups I (laparotomy, n = 6) and II (laparoscopy, n = 6). Group III (laparoscopy, n = 6) underwent a 120-minute long pneumoperitoneum in absence of aortic clamping (sham group). Ventilatory and hemodynamic parameters and renal function were serially determined in all groups. A significant decrease in pH and significant increase in PaCO2 were observed in group II, whereas no changes in these parameters were seen in group I and III. All variables returned to values similar to baseline in groups I and II 60 minutes after declamping. A significant increase in renal resistive index was evidenced during laparoscopy, with significantly higher values seen in Group II. Thus a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause decreased renal perfusion and acidosis, thus negatively affecting the patient's general state during this type of surgery.

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Section: Discussionsupporting

confidence: 74%

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Martín-Cancho

Crisóstomo

Soria

et al. 2008

Anesthesiology Research and Practice

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“…This adverse effect on myocardial contractility is described in the context of aneurysm repair, where collateral pathways do not exist to support the increased afterload incurred by complete aortic occlusion. 8, 10 …”

Section: Discussionmentioning

confidence: 99%

Automated variable aortic control versus complete aortic occlusion in a swine model of hemorrhage

Williams

Neff

Johnson

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Future endovascular hemorrhage control devices will require features that mitigate the adverse effects of vessel occlusion. Permissive regional hypoperfusion (PRH) with variable aortic control (VAC) is a novel strategy to minimize hemorrhage and reduce the ischemic burden of complete aortic occlusion (AO). The objective of this study was to compare PRH with VAC to AO in a lethal model of hemorrhage. Methods Twenty-five swine underwent cannulation of the supraceliac aorta, with diversion of aortic flow through an automated extracorporeal circuit. After creation of uncontrolled liver hemorrhage, animals were randomized to 90 minutes of treatment: Control (full, unregulated flow; n=5) AO (no flow; n=10), and PRH with VAC (dynamic distal flow initiated after 20 minutes of AO; n=10). In the PRH group, distal flow rates were regulated between 100–300mL/min based on a desired, preset range of proximal mean arterial pressure (MAP). At 90 minutes, damage control surgery, resuscitation, and restoration of full flow ensued. Critical care continued for 4.5 hours or until death. Hemodynamic parameters and markers of ischemia were recorded. Results Study survival was 0%, 50%, and 90% for control, AO, and VAC respectively (p<0.01) (Figure). During intervention, VAC resulted in more physiologic proximal MAP (84mmHg±18 vs. 105±9mmHg, p<0.01) and higher renal blood flow than AO animals (p=0.02). During critical care, VAC resulted in higher proximal MAP (73 mmHg±8 vs. 50 mmHg±6, p<0.01), carotid and renal blood flow (p<0.01), lactate clearance (p<0.01), and urine output (p<0.01) than AO despite requiring half the volume of crystalloids to maintain proximal MAP ≥50 mmHg (p<0.01). Conclusion Permissive regional hypoperfusion with variable aortic control minimizes the adverse effects of distal ischemia, optimizes proximal pressure to the brain and heart, and prevents exsanguination in this model of lethal hemorrhage. These findings provide foundational knowledge for the continued development of this novel paradigm and inform next generation endovascular designs.

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“…Specifically, pre-existing diastolic dysfunction, diuretic or fluid administration, change in peripheral vascular resistance (eg, vasopressor medications, post-LEB changes in peripheral arterial resistance), and aortic clamping all have been implicated to affect ventricular function. 23–25 …”

Section: Discussionmentioning

confidence: 99%

Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

Scali

Bertges

Neal

et al. 2015

Journal of Vascular Surgery

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Objective Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Methods Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR <75 beats/min on operating room arrival. Delta HR (DHR) was defined as highest intraoperative HR – AHR Procedure-specific MACE models were derived for risk stratification, and generalized estimating equations were used to account for clustering of center effects. HR, beta-blocker exposure, cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P < .004 was used to declare significance. Results There were 13,291 patients reviewed (LEB, n = 8155 [62%]; AFB, n = 2629 [18%]; open AAA, n = 2629 [20%]). Rates of any preoperative beta-blocker exposure were as follows: LEB, 66.5% (n = 5412); AFB, 57% (n = 1342); and open AAA, 74.2% (n = 1949). AHR and DHR outcome association was variable across patients and procedures. AHR <75 beats/min was associated with increased postoperative myocardial infarction risk for LEB patients across all risk strata (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.03–1.9; P = .03), whereas AHR<75 beats/min was associated with decreased dysrhythmia risk (OR, 0.42; 95% CI, 0.28–0.63; P = .0001) and 30-day death (OR, 0.50; 95% CI, 0.33–0.77; P = .001) in patients at moderate and high cardiac risk. These HR associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. Conclusions The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure.

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Monitoring with two-dimensional transesophageal echocardiography

Cited by 179 publications

References 17 publications

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Automated variable aortic control versus complete aortic occlusion in a swine model of hemorrhage

Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

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