Hemodynamic MonitoringCentral venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?
Introduction
Many higher risk coronary artery bypass graft (CABG) surgery patients have a pulmonary artery (PA) catheter placed preoperatively to help guide clinical management [1], [2]. Attention is often directed predominately to assuring that patients have adequate cardiac output and index in the perioperative period. However, central venous pressure (CVP) is a simple hemodynamic parameter also easily obtained during the acute recovery period [1]. Despite its routine measurement, the importance and role of CVP as a prognostic indicator have not received widespread study or attention.
We sought to investigate the prognostic value of CVP measurement among a multi-institutional cohort of higher risk CABG patients in the postsurgical intensive care unit setting. Our specific questions were whether CVP correlates with death and/or renal failure; whether the relationship, if any, is continuous or stepped; and whether there exists any association between CVP and outcome independent of baseline preoperative factors and/or cardiac index.
Section snippets
The Contemporary Analysis of Perioperative Cardiovascular Surgical Care registry
The Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) registry is a sample of 2390 high-risk patients from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) in whom retrospective chart reviews were performed to supplement existing registry data. Clinical data for the STS ACSD were collected using methods described in full detail elsewhere [3]. Data definitions are standardized, and site data coordinators receive initial and ongoing training
Patient population
Fig. 1 displays a patient flow diagram. Central venous pressure was not captured in 126 patients at either ICU arrival or at 6 hours. Inhospital/30-day mortality rate in patients excluded from and included in the analysis were similar (5.0% vs 4.8%). In addition, 263 patients underwent concomitant tricuspid or mitral valve repair or replacement, and those patients were excluded (Fig. 1). Table 1 displays the baseline clinical and operative characteristics of the 2001 CABG patients with CVP
Discussion
Central venous pressure, the downstream pressure of the systemic venous system, is frequently measured in patients undergoing CABG surgery. Despite often routine monitoring of CVP, a paucity of clinical data exists regarding the prognostic value of this measurement after CABG surgery. Existing literature focuses on the degree to which CVP gives information on right ventricular end-diastolic pressure and the limitations of CVP as a surrogate variable for left ventricular preload, but little
Conclusions
In this observational cohort, CVP after CABG surgery was predictive of early mortality and renal failure, independent of cardiac index and other important clinical variables. Our study highlights the importance of using CVP routinely at 6 hours after ICU arrival, a simple and easily performed tool, to assess risk of early death and renal failure in patients undergoing CABG surgery. Whether CVP can be used to guide therapy in this setting deserves further investigation.
References (12)
- et al.
Validity of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database
Ann Thorac Surg
(2004) - et al.
Comparison of cardiac surgery volumes and mortality rates between the Society of Thoracic Surgeons and Medicare databases from 1993 through 2001
Ann Thorac Surg
(2007) - et al.
Unreliability of hemodynamic indexes of left ventricular size during cardiac surgery
Ann Thorac Surg
(1987) - et al.
Use of postoperative information to predict mortality rates for patients who have long stays in the intensive care unit after coronary artery bypass grafting
Heart Lung
(1998) - et al.
Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease
J Am Coll Cardiol
(2009) - et al.
Importance of venous congestion for worsening of renal function in advanced decompensated heart failure
J Am Coll Cardiol
(2009)
Cited by (55)
Intraoperative venous congestion and acute kidney injury in cardiac surgery: an observational cohort study
2021, British Journal of AnaesthesiaFirst step toward uncovering perioperative congestive encephalopathy
2021, Journal of Thoracic and Cardiovascular SurgeryTiming and Trends of Right Atrial Pressure and Risk of Right Heart Failure After Left Ventricular Assist Device Implantation
2020, Journal of Cardiac FailureReinterpreting Renal Hemodynamics: The Importance of Venous Congestion and Effective Organ Perfusion in Acute Kidney Injury
2020, American Journal of the Medical Sciences