Six-month prognostic impact of hemodynamic profiling by short minimally invasive monitoring after cardiac surgery

Introduction: Studies have shown that a hemodynamicguided therapy improves the post operative outcomes of highrisk patients.This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a postcardiac surgery stepdown unit (SDU), may identify patients at higher risk of 6month adverse events after cardiac surgery. Methods: From December 2016May 2017,173 patients were admitted in SDU within 2448 hours of major cardiac surgery procedure, and submitted to clinical, laboratoristic and echocardiographic evaluation and a 1hour PRAM recording to obtain a biohumoral snapshot of individual patient’s.156 173 patients (17 patients were lost at followup) were phone interviewed six months after surgery,to evaluate, as a composite endpoint, the adverse events during followup. A multivariable logistic regression analysis was used to identify a model clinicalbiohumoral (CBM) and clinicalbiohumoral hemodynamics (CBHM). Results: No data from past clinical history and no conventional risk score (EuroScore II, STS score)independently predicted the risk of 6month major events in our study. The risk of adverse events at sixmonth followup was directly related, in the CBM, to sustained postoperative cardiac arrhythmias, higher values of NTproBNP and of arterial pH; inversely related to values of hsCreactive protein (hsCRP) and, in the CBHM, to low values of cardiac cycle efficiency (CCE) and dP/dtmax. Conclusion: Our study although limited by its observational nature and by the limited number of patients enrolled, showed that a short period of minimally invasive hemodynamic monitoring increased the accuracy to identify patients at major risk of midterm events after cardiac surgery.