Cardiac Surgery – ABC CARDIOL

IJCS

Editorial

Risk Stratification in Patients Hospitalized With Infective Endocarditis Undergoing Cardiac Surgery: How Sharp Are We?

Ana Margarida Martins et al. Catarina Sousa

Infective endocarditis (IE) is an infrequent yet life-threatening and disabling condition, with an estimated incidence between 3 and 12 cases per 100,000 subjects per year.^, Recent epidemiological studies have suggested a rising trend in the incidence of IE, potentially attributable to factors such as an aging population and a growing group of susceptible patients with congenital heart disease, intracardiac prosthesis or devices, and chronic renal failure on dialysis. Limited information is available concerning Brazil’s temporal trends on IE incidence and clinical outcomes. The primary source of evidence regarding the IE scenario in Brazil stems from single or multicenter observational studies.^– Analyzing available data, it appears that IE predominantly affects younger male patients in Brazil. The most prevalent microbial culprits are Staphylococcus, followed by Enterococcus and Streptococcus species; rheumatic heart disease is an important underlying heart condition as well.

The diverse clinical spectrum of IE, coupled with the substantial risk of complications and the limited availability of randomized clinical trials on IE, justify that it continues to be a prognostic challenge. Despite the unquestionable diagnostic and therapeutic advances in the management of IE in recent decades, its prognosis is still marked by high rates of complications and significant in-hospital mortality. In developed countries, IE is associated with mortality rates of approximately 20%,^,, whereas in low- and middle-income countries, the mortality of IE ranges from 15% to 30%. The predominant focus in studies on IE has been the evaluation of clinical factors that may influence the course of the disease. In one of these studies, a machine learning-based analysis identified peripheral stigmata, nosocomial IE, the absence of vegetation, and surgery in the presence of neurologic complications as characteristics associated with higher in-hospital mortality.

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IJCS

Original Article

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? – A Retrospective Cohort Study

Daniela Meirelles do Nascimento et al. Cíntia Ehlers Botton Felipe Vargas Santos Márcia Cristina Rover … Marília Santos Moura Bruna Müller Leão Beatriz D. Schaan

Abstract

Background

Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age.

Objective

To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery.

Methods

A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted.

Results

The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015).

Conclusions

Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

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IJCS

Original Article

Gender Based Analysis of a Population Series of Patients Hospitalized with Infective Endocarditis in Portugal – How do Women and Men Compare?

Catarina Sousa et al. Paulo Jorge Nogueira Fausto J. Pinto

Abstract

Background:

The impact of gender on the outcome of patients hospitalized with infective endocarditis (IE) is not fully understood.

Objective:

To verify the association between gender and the clinical profile of patients hospitalized with IE, treatment strategies, and clinical outcomes.

Methods:

This is a retrospective nationwide study of patients hospitalized with IE, based on hospital admissions between 2010 and 2018 in Portugal. Descriptive statistics were used to present variables. An inferential analysis was performed using multiple logistic regression. A 95% confidence interval and a 5% significance level were considered.

Results:

In total, 3266 (43.1%) women and 4308 (56.9%) men were hospitalized with IE. The women were older (76 vs 69 years old, p<0.001), more frequently presented arterial hypertension (39.8% vs 35.4%, p<0.001) and atrial fibrillation (29.5% vs 21.2%, p<0.001), and had less cardiovascular comorbidities. Acute heart failure was more common in women (32.9 vs 26.9%, p<0.001) and acute renal failure (13.6% vs 11.7%, p<0.001) and sepsis (12.1% vs 9.1%, p<0.001), in men. Women were less likely to undergo cardiac surgery (OR 0.48 – 95%CI 0.40–0.57, p<0.001) and had a higher postoperative mortality (OR 1.84, 95% CI 1.19–2.84, p=0.006). In-hospital mortality rates were comparable between genders (20.3% vs 19.6%, p=0.45).

Conclusions:

Women were less likely to undergo cardiac surgery when hospitalized with IE, and the female gender was a predictor factor for postoperative mortality. Overall, in-hospital mortality was not influenced by gender. Further research is necessary to fully clarify the impact of gender on IE management and outcomes.

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IJCS

Original Article

Prevalence of Frailty in Patients Undergoing Cardiac Valve Surgery: Comparison of Frailty Tools

Gabriela Harada et al. Monique Carvalho Andrade Julia Nobrega Brito Caio de Assis Moura Tavares … Flávio Tarasoutchi Pablo Maria Alberto Pomerantzeff Luiz Bortolotto Maria Ignez Zanetti Feltrim

Abstract

Background

There is no consensus among tools for assessing frailty.

Objective

To evaluate the prevalence of frailty according to different tools in patients referred for elective valve cardiac surgery.

Methods

This is a cross-sectional study. All patients were ≥ 18 years of age, clinically stable. The following patients were excluded: those unable to perform the tests because of physical, cognitive, or neurological limitations; those requiring non elective/emergency procedures or hemodynamic instability. During the preoperative cardiology visit, frailty was assessed by the Short Physical Performance Battery (SPPB), the Frailty Deficit Index (FDI), handgrip strength, and gait speed 3m. For the entire analysis, the statistical significance was set at 5%.

Results

Our cohort consisted of 258 subjects. From the total cohort, 201 were ≤ 70 years of age (77.9%), the predominant etiology according to rheumatic disease (50.7% vs 8.8%; p=0.000) with double mitral lesion (24.9% vs 0%; p=0.000). Frailty was present in 32.9% according SPPB, 29.1% with reduced muscular strength. and 8.9% with FDI. Handgrip strength was weaker in elderly patients (26.7 vs 23.6; p=0.051) and gait speed was lower in the younger group, in which 36% were considered frail (36% vs 14%; p=0.002). Variables associated with frailty were age ≥ 70 years, female gender, aortic stenosis, and regurgitation.

Conclusion

Frailty in adult patients who will have elective heart valve surgery is present even in the younger groups, although the older group with comorbidities are more frail. Frailty was more clearly shown by the SPPB than by the FDI and handgrip tests.

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IJCS

Original Article

Transfusion of Blood Products in the Postoperative of Cardiac Surgery

Antonieta Moraes et al. Juliana Neves Giordani Cristiane Tavares Borges Pauline Eloise Mariani … Laura Maggi da Costa Leonardo Hennig Bridi Ari Tadeu Lirio dos Santos Renato Kalil

Abstract

Background:

The indiscriminate use of blood transfusion in surgery has been associated with increased risk of infection and increased length of hospital stay.

Objective:

To identify the average amount of bleeding and rates of transfusion of blood products in the postoperative period of patients undergoing cardiac surgery in a cardiology center.

Methods:

Medical records of patients who underwent myocardial revascularization surgery and/or heart valve replacement with use of cardiopulmonary bypass (CPB) were analyzed. Perioperative data such as CPB time, hematocrit and hemoglobin values were collected after surgery. The amount of bleeding (mL), blood transfusion (IU), clinical complications and time of hospitalization were also recorded. The correlation between bleeding in the postoperative period and blood transfusion was performed using the Spearman correlation. A p < 0.05 was considered statistically significant.

Results:

A total of 423 patients undergoing coronary artery bypass grafting (51.5%) or heart valve replacement (33.6%) were included. During the first 24 hours, the average bleeding volume was 353.3 ± 268.3 mL. Transfusion of blood products was required in 40.1% of cases, most frequently (70.6%) in the immediate postoperative period. Red blood cell concentrate was the most frequently used product (22.9% and 60%).

Conclusion:

The occurrence of bleeding in the cases was low, and when transfusion of blood components was indicated, red blood cell concentrates were the most widely used component. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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IJCS

Original Article

A Retrospective Study on Unfractionated Bovine Heparin Safety in On-Pump Cardiac Surgery

Fernando Antonio de Lima Torres et al. Andressa C. B Torres Allinson Ribeiro Cauê O Maia … Fernanda P Almeida João Roceto Jorge A Matkovski Matheus G Kovalski Vanessa A Pizato Tatiana M. G Cordeiro

Abstract

Background:

Heparin decreases the risks of thrombotic phenomena in extracorporeal circulation. However, it must present a robust safety profile itself, especially for bleeding. Contamination of porcine heparin demands an alternative source and consequent assessment of safety.

Objective:

To evaluate the safety of unfractionated bovine heparin during on-pump cardiac surgery.

Methods:

Descriptive, retrospective study, evaluating medical records from all patients who had on-pump cardiac surgery over four years. We observed the occurrence of bleeding, thrombocytopenia, postoperative vasoplegia, activated clotting time values and any other coagulation phenomena as safety profile parameters.

Results:

We evaluated 204 medical records reporting the use of unfractionated bovine heparin. 66.18% of the patients presented thrombocytopenia, 1.04% presented bleeding of more than 2000 mL in the first 24 hours of the postoperative period. One patient presented clots in the surgical field. Median activated clotting time was 137 seconds at baseline, 803 seconds after the first dose of heparin and, after protamine, it returns to similar baseline values, that is, 149.5 seconds.

Conclusion:

Unfractionated bovine heparin did not present unusual adverse effects and can be considered safe for on-pump cardiac surgery.

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IJCS

Case Report

Fourteen Years’ Survival After Batista Operation: The Short History of a Long Journey

Gustavo Luiz Gouvêa de Almeida Junior et al. Waldir Jazbik Juliana Visconti Morgado Gustavo Luiz Gouvêa de Almeida

Abstract

A 41-year-old man with end-stage heart failure due to nonischemic dilated cardiomyopathy was submitted to the Batista procedure as an alternative to heart transplantation. With surgery, the patient showed progressive clinical amelioration, achieving long-term stable NYHA functional class II, despite gradual dilation of the heart chambers. Persistent atrial fibrillation appeared on the last year of life, his clinical condition deteriorated, and the patient died 14 years, four months, and 13 days after the operation. To the best of our knowledge this seems to be the longest reported survival for a patient submitted to Batista operation.

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ABC

Original Article

Mechanical versus biological aortic valve implants in the elderly. A comparison of early and mid-term results

Lars I. Thulin et al. Johan L. Sjögren

OBJECTIVE: Our aim was to compare, in a non randomized study, the surgical outcome in elderly patients with mechanical (Group 1; n=83) and bioprosthetic valve implants (Group 2; n=136). METHODS: During a three year period, 219 patients >75 years underwent Aortic Valve Replacement. The groups matched according to age, sex, comorbidity, valve pathology and concomitant Coronary Artery Bypass Surgery. Follow-up was a total of 469 patient-years (mean follow-up 2.1 years, maximum 4,4 years). RESULTS: Operative mortality was zero and the overall early mortality was 2.3 % (within 30 days). Actuarial survival was 87.5 ± 4.0% and 66.1 ± 7.7% (NS) at 4 years in Group 1 and Group 2, respectively. Freedom from valve-related death was 88.9 ± 3.8% in Group 1 and 69.9±7.9% (NS) in Group 2 at 4 years. CONCLUSION: Aortic Valve Replacement in the elderly (>75 years) is a safe procedure even in cases where concomitant coronary artery revascularization is performed. Only a few anticoagulant-related complications were reported and this may indicate that selected groups of elderly patients with significant life expectancy may benefit from mechanical implants .

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ABC

Original Article

Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome

Ilmar Köhler et al. Paulo J. Saraiva Orlando B. Wender Alcides J. Zago

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5%) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation.

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ABC

Original Article

Infective endocarditis: surgical therapy

Luís Sérgio de Moura Fragomeni et al. Fabiano Fernandes Vieira Júlio Cesar de Mello Bajerski Roque Paulo Falleiro … Gustavo Hoppen Iselso Sartori

OBJECTIVE: To assess the major causes of surgical morbidity and mortality in patients with infective endocarditis operated upon in a regional cardiology center. METHODS: Thirty-four patients underwent surgical treatment for infective endocarditis. Their ages ranged from 20 to 68 years (mean of 40.6) and 79% were males. Their NYHA functional classes were as follows: IV – 19 (55.8%) patients; III – 12 (35.2%) patients; II – 3 (8.8%) patients. Blood cultures were positive in only 32% of the cases. Eight patients had already undergone previous cardiac surgery, whose major indication (82.3%) was heart failure refractory to clinical treatment. RESULTS: Four (11.7%) patients died at the hospital. Follow-up was complete in 26 (86%) patients. Five (14.7%) patients died later, 12, 36, 48, 60, and 89 months after hospital discharge. Of the 21 patients being currently followed up, 1 is in NYHA functional class III, and 5 in NYHA functional class II. CONCLUSION: A high degree of clinical suspicion, at an early diagnosis, and indication of surgical treatment prior to deterioration of left ventricular function and installation of generalized sepsis may improve prognosis.

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ABC

Original Article

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Emília Nozawa et al. Eliane Kobayashi Marta Erika Matsumoto Maria Ignêz Zanetti Feltrim … Maria José Carvalho Carmona José Otávio Costa Auler Júnior

OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

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Original Article

Late Results of Endoventricular Patch Plasty Repair in Akinetic and Dyskinetic Areas After Acute Myocardial Infarction

Paulo R. Prates et al. Abud Homsi Neto Lucas Maynard Lovato Guaracy F. Teixeira Fº … João R. M. Sant'Anna Luiz M. Yordi Renato A. K. Kalil Ivo A. Nesralla

OBJECTIVE – To assess the surgical results of endoventricular patch plasty repair in akinetic and dyskinetic left ventricular areas. METHODS – We studied 52 patients who had undergone endoventricular patch plasty repair associated with myocardial revascularization. The preoperative functional class distribution was as follows: class I in 1 (1.9%) patient; class II in 2 (3.8%) patients; class III in 23 (44.2%) patients; and class IV in 26 (50%) patients. RESULTS – The immediate mortality rate was 7.6% (4 patients). The clinical outcome of 44 patients followed up within a mean postoperative time of 29±25 months was as follows: class I in 33 (75%) patients; class II in 7 (15.9%) patients; class III in 2 (4.5%) patients; and class IV in 2 (4.5%) patients. Comparison between pre- and postoperative catheterization in 21 patients showed that the ejection fraction increased from 46.3% to 51.3% (p=0. 17); the left ventricular systolic volume decreased from 76.4 mL to 57.5 mL, (p=0.078); and the left ventricular diastolic volume decreased from 141.2 mL to 105.8 mL (p=0.0 73). These findings showed the tendency toward improvement, but with nonsignificant results. CONCLUSION – The technique proved to be effective, to have a low mortality rate, to cause significant clinical improvement, an increase in ejection fraction, and a reduction in left ventricular volumes.

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Original Article

Short-term follow-up of patients after aneurysmectomy of the left ventricle

Wilson Luiz da Silveira et al. Adélio Ferreira Leite Érica Coelho Garcia Soares Max Weyler Nery … Antônio Fernando Carneiro Vilmondes Gonçalves de Oliveira

OBJECTIVE: Left ventricular aneurysm is a complication of myocardial infarction that can best be treated by reconstructive surgeries that can restore ventricular geometry. We analyzed immediate results in a group of consecutive patients who underwent surgical correction of left ventricular aneurysms. METHODS: From January ’90 to August ’99, 94 patients – mean age 58.4 (ranging from 36 to 73 years), 65 (69.1%) males and 9 ( 30.8%) females – were operated upon. Pre-operative ejection fraction ranged from 0.22 to 0.58 (mean = 0.52), and the aneurysm was located in the antero-lateral area in 90.4% of the cases. Functional class III and IV (NYHA) was present in 82 (87.2%) patients, and 12 (12.7%) were in functional class I and II. Congestive heart failure was the most frequent cause (77.6%), occurring in isolation in 24.4% or associated with coronary artery diseases in 53.2%. RESULTS: Short-term follow-up showed a 7.4% mortality, and low cardiac output was the main cause of death. Coming off pump was uneventful in 73 patients (77.6%), with a 3.2% mortality and with the use of inotropics in 20 (21.3%). One patient (1%) did not come off the pump. CONCLUSION: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class.

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Original Article

Outcome of acute renal failure associated with cardiac surgery in infants

João Egídio Romão Jr et al. Miguel G. Fuzissima Armando F. Vidonho Jr Irene L. Noronha … Paulo Sérgio L. Quintaes Hugo Abensur Maria Regina T. Araújo Ivanir Freitas Jr Marcello Marcondes

OBJECTIVE: To analyze the impact of acute renal failure (ARF) on the evolution of infants undergoing cardiac surgery. METHODS: We assessed 15 infants undergoing cardiac surgery who developed (ARF). Their demographic, clinical and surgical data, and evolution were analyzed. RESULTS: Their mean age was 4.4±4.0 months (8 days to 24 months). Twelve infants were males, and 4 patients already had ARF at surgery. The primary cause of ARF was immediate acute cardiac dysfunction in 10 infants, cardiac dysfunction associated with sepsis in 2 infants, and isolated sepsis in 3 infants. All children depended on mechanical ventilation during their postoperative period, 14 infants used vasoactive drugs, and 11 had an infectious process associated with ARF. Thirteen infants required dialytic treatment. Eleven infants developed oluguric ARF, and all had to undergo peritoneal dialysis; of the 4 patients with non-oliguric, 2 required dialysis, the main indication being hypervolemia. Of these 13 dialyzed infants, 4 died in the first 24 hours because of the severity of the underlying cardiac disease (mean urea level of 49±20 mg/dl). The mortality rate for the entire group was 60% , and it was higher among the patients with oliguria ARF (73% vs 25%, p<0.001). The cause of death was acute cardiac dysfunction in 6 infants (early type-1ARF) and sepsis in the 3 remaining infants (late type-2 ARF). CONCLUSION: The mortality rate of ARF associated with cardiac surgery in infants was hight, being higher among children with oliguria; peritoneal dialysis was indicated due to clinically uncontrolled hypervolemia and not to the uremic hypercatabolic state.

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Original Article

Aortopulmonary window. Clinical and surgical assessment of 18 cases

Andressa Mussi Soares et al. Edmar Atik Tâmara Martins Cortêz Angela Maria T. Albuquerque … Claudia P. Castro Miguel Barbero-Marcial Munir Ebaid

OBJECTIVE: Aortopulmonary window (APW) is an uncommon congenital malformation. Its clinical presentation is dependent on the size of the defect and on the associated lesions. We evaluated our experience with this anomaly and compared it with 296 cases reported in the literature. METHODS: Retrospective study of 18 patients diagnosed as having APW (age range from 13 days to 31 years, 13 (72.2%) females), divided into two groups: Group A (GA): 10 patients with isolated APW, and Group B (GB): 8 patients with associated lesions. RESULTS: Heart failure occurred in 14 patients, and cyanosis in 3: 2 from GB (tetralogy of Fallot – TF, and double outlet right ventricle – DORV), and one from GA with pulmonary hypertension. In 5 patients from GA the diagnosis of mitral regurgitation was made based on a systolic murmur and LV hypertrophy on the EKG. In GB, clinical findings were determined by the associated defect. Diagnosis was established by echocardiography in 11 (61.2%) of the patients. In 3 patients, a wrong diagnosis of mitral regurgitation was made, in 1 a patent ductus arteriosus was diagnosed and in 3 others, the diagnosis of APW was masked by other important associated defects (2 cases of DORV and 1 case of TF). The diagnosis was made by catheterization in 3 (16.6%) patients, by surgery in 3 (16.6%) and by necropsy in 1 (5.5%). Corrective surgery was performed in 14 (77.7%) patients, with one immediate death and good long-term follow-up in the remaining patients. CONCLUSION: APW can be confused with other defects. Clinical findings, associated with an adequate echocardiogram can provide the information for the correct diagnosis.

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Original Article

Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

Desanka Dragosavac et al. Sebastião Araújo Maria do Carmo Monteiro Carieli Renato G. G. Terzi … Sanja Dragosavac Reinaldo Wilson Vieira

OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP). METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI), systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI), and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2) and consumption (VO2), p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS). Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.

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