Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 3 , Pages 331-339 , June 2006

Importance of Relative Pulmonary Hypertension in Cardiac Surgery: The Mean Systemic-to-Pulmonary Artery Pressure Ratio

  • Arnaud Robitaille, MD

      Affiliations

    • Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • André Y. Denault, MD, FRCPC

      Affiliations

    • Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
    • Corresponding Author InformationAddress reprint requests to André Y. Denault, MD, FRCPC, Department of Anesthesia, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada.
  • ,
  • Pierre Couture, MD, FRCPC

      Affiliations

    • Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • Sylvain Bélisle, MD, FRCPC

      Affiliations

    • Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • Annik Fortier, MSc

      Affiliations

    • Department of Biostatistics, Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • Marie-Claude Guertin, PhD

      Affiliations

    • Department of Biostatistics, Montreal Heart Institute, Montreal, Quebec, Canada
  • ,
  • Michel Carrier, MD, FRCSC

      Affiliations

    • Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
  • ,
  • Raymond Martineau, MD, FRCPC

      Affiliations

    • Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada

References 

  1. Tuman KJ , McCarthy RJ , March RJ , et al.   Morbidity and duration of ICU stay after cardiac surgery. A model for preoperative risk assessment . Chest . 1992;102:36–44
  2. Roques F , Nashef SA , Michel P , et al.   Risk factors and outcome in European cardiac surgery (Analysis of the EuroSCORE multinational database of 19030 patients) . Eur J Cardiothorac Surg . 1999;15:816–822
  3. Reich DL , Bodian CA , Krol M , et al.   Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery . Anesth Analg . 1999;89:814–822
  4. Bernstein AD , Parsonnet V . Bedside estimation of risk as an aid for decision-making in cardiac surgery . Ann Thorac Surg . 2000;69:823–828
  5. Erickson KW , Costanzo-Nordin MR , O’Sullivan EJ , et al.   Influence of preoperative transpulmonary gradient on late mortality after orthotopic heart transplantation . J Heart Transplant . 1990;9:526–537
  6. Therrien J , Dore A , Gersony W , et al.   CCS Consensus Conference 2001 update (Recommendations for the management of adults with congenital heart disease. Part I) . Can J Cardiol . 2001;17:940–959
  7. Gomez CM , Palazzo MG . Pulmonary artery catheterization in anaesthesia and intensive care . Br J Anaesth . 1998;81:945–956
  8. Ge Z , Zhang Y , Kang W , et al.   Noninvasive evaluation of right ventricular and pulmonary artery systolic pressures in patients with ventricular septal defects (Simultaneous study of Doppler and catheterization data) . Am Heart J . 1993;125:1073–1081
  9. Hache M , Denault A , Belisle S , et al.   Inhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery . J Thorac Cardiovasc Surg . 2003;125:642–649
  10. Quinones MA , Otto CM , Stoddard M , et al.   Recommendations for quantification of Doppler echocardiography (A report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography) . J Am Soc Echocardiogr . 2002;15:167–184
  11. Rakowski H , Appleton C , Chan KL , et al.   Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography (From the Investigators of Consensus on Diastolic Dysfunction by Echocardiography) . J Am Soc Echocardiogr . 1996;9:736–760
  12. Garcia MJ , Thomas JD , Klein AL . New Doppler echocardiographic applications for the study of diastolic function . J Am Coll Cardiol . 1998;32:865–875
  13. Khouri SJ , Maly GT , Suh DD , et al.   A practical approach to the echocardiographic evaluation of diastolic function . J Am Soc Echocardiogr . 2004;17:290–297
  14. Bernard F , Denault A , Babin D , et al.   Diastolic dysfunction is predictive of difficult weaning from cardiopulmonary bypass . Anesth Analg . 2001;92:291–298
  15. Costachescu T , Denault A , Guimond JG , et al.   The hemodynamically unstable patient in the intensive care unit (Hemodynamic vs) . transesophageal echocardiographic monitoring. Crit Care Med . 2002;30:1214–1223
  16. Fleiss JL . In: Statistical Methods for Rates and Proportions . (ed 2). New York: Wiley; 1981;
  17. Parsonnet V , Dean D , Bernstein AD . A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease . Circulation . 1989;79:I3–I12
  18. O’Connor GT , Plume SK , Olmstead EM , et al.  Northern New England Cardiovascular Disease Study Group   Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery . Circulation . 1992;85:2110–2118
  19. Tu JV , Jaglal SB , Naylor CD . Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario . Circulation . 1995;91:677–684
  20. Dupuis JY , Wang F , Nathan H , et al.   The cardiac anesthesia risk evaluation score (A clinically useful predictor of mortality and morbidity after cardiac surgery) . Anesthesiology . 2001;94:194–204
  21. Haraldsson SA , Kieler-Jensen N , Ricksten SE . The additive pulmonary vasodilatory effects of inhaled prostacyclin and inhaled milrinone in postcardiac surgical patients with pulmonary hypertension . Anesth Analg . 2001;93:1439–1445
  22. Fortier S , DeMaria RG , Lamarche Y , et al.   Inhaled prostacyclin reduces cardiopulmonary bypass-induced pulmonary endothelial dysfunction via increased cyclic adenosine monophosphate levels . J Thorac Cardiovasc Surg . 2004;128:109–116
  23. Lamarche Y , Malo O , Thorin E , et al.   Inhaled but not intravenous milrinone prevents pulmonary endothelial dysfunction after cardiopulmonary bypass . J Thorac Cardiovasc Surg . 2005;130:83–92
  24. Marcus JT , Vonk NA , Roeleveld RJ , et al.   Impaired left ventricular filling due to right ventricular pressure overload in primary pulmonary hypertension (Noninvasive monitoring using MRI) . Chest . 2001;119:1761–1765
  25. Xie GY , Berk MR , Smith MD , et al.   Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure . J Am Coll Cardiol . 1994;24:132–139
  26. Giannuzzi P , Temporelli PL , Bosimini E , et al.   Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction . J Am Coll Cardiol . 1996;28:383–390
  27. Pozzoli M , Traversi E , Cioffi G , et al.   Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure . Circulation . 1997;95:1222–1230
  28. Pinamonti B , Zecchin M , Di Lenarda A . Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy (An ominous prognostic sign) . J Am Coll Cardiol . 1997;29:604–612
  29. Sun JP , James KB , Yang XS , et al.   Comparison of mortality rates and progression of left ventricular dysfunction in patients with idiopathic dilated cardiomyopathy and dilated versus nondilated right ventricular cavities . Am J Cardiol . 1997;80:1583–1587
  30. Vaskelyte J , Stoskute N , Kinduris S , et al.   Coronary artery bypass grafting in patients with severe left ventricular dysfunction (Predictive significance of left ventricular diastolic filling pattern) . Eur J Echocardiogr . 2001;2:62–67
  31. Liu J , Tanaka N , Murata K , et al.   Prognostic value of pseudonormal and restrictive filling patterns on left ventricular remodeling and cardiac events after coronary artery bypass grafting . Am J Cardiol . 2003;91:550–554
  32. Carricart M , Denault A , Couture P , et al.   Incidence and significance of abnormal hepatic venous Doppler velocities before cardiac surgery . J Cardiothorac Vasc Anesth . 2005;19:751–758
  33. Connors AF , Speroff T , Dawson NV , et al.  SUPPORT Investigators   The effectiveness of right heart catheterization in the initial care of critically ill patients . JAMA . 1996;276:889–897
  34. Gnaegi A , Feihl F , Perret C . Intensive care physicians’ insufficient knowledge of right-heart catheterization at the bedside (Time to act?) . Crit Care Med . 1997;25:213–220
  35. Iberti TJ , Fischer EP , Leibowitz AB , et al.  Pulmonary Artery Catheter Study Group   A multicenter study of physicians’ knowledge of the pulmonary artery catheter . JAMA . 1990;264:2928–2932

 Supported by the Fonds de la recherche en santé du Québec CAS Abbott Career Award, and the Fondation de l’Institut de Cardiologie de Montréal.

PII: S1053-0770(05)00466-0

doi: 10.1053/j.jvca.2005.11.018

Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 3 , Pages 331-339 , June 2006