Radial-to-femoral pressure gradient quantification in cardiac surgery

Figures

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  Radial-to-femoral arterial pressure gradient in cardiac surgery.

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  Figure 1. Radial (Pra) and femoral arterial pressures (Pfa) in a 60-year-old man undergoing coronary revascularization. A, No significant difference in the Pra and Pfa before cardiopulmonary bypass (CPB). B, Note the significant mean gradient of 38 mm Hg that appears during CPB. C, Despite a Pra of 28 mm Hg, brain saturation (rSO2) and transcranial Doppler (109% from baseline) were normal. D, Intraoperative evolution of the Pfa (white) and Pra (green) during CPB. Note the significant gradient that appears only during CPB. HR, Heart rate; TCD, transcranial Doppler; PSV, peak systolic velocity; MV, mean velocity; EDV, end-diastolic velocity; PI, pulsatility index; Ppa, pulmonary artery pressure.

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  Figure 2. A and B, Radial (Pra) and femoral arterial pressure (Pfa) in a 75-year-old man before (A) and after (B) cardiopulmonary bypass (CPB) for aortic valve replacement. There was no difference in the Pra and Pfa before CPB; however, note the significant systolic (47 mm Hg) and mean (17 mm Hg) radial-to-femoral pressure gradient (RFPG) after CPB. C, This patient had significant high-intensity transient signals (HITS) after weaning from CPB, resulting in brain desaturation and associated with hemodynamic instability. D, Postoperative evolution of the Pra (green) and Pfa (white) in a 76-year-old man after revascularization. Note the RFPG that appeared during CPB but became highly significant after CPB. HR, Heart rate; TCD, transcranial Doppler; PSV, peak systolic velocity; MV, mean velocity; EDV, end-diastolic velocity; PI, pulsatility index; Δ%, change from baseline; Ppa, pulmonary artery pressure.

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  Figure 3. A, Radial (Pra) and femoral arterial pressure (Pfa) evolution in a 54-year-old man undergoing a Ross procedure. Note the significant systolic radial-to-femoral gradient from the beginning, during cardiopulmonary bypass (CPB), and until the end of the procedure. B, Brain saturation % change (%rSO2) was normal during the procedure except after weaning from CPB, when it dropped transiently. AUC, Area under the curve; ΔSpO2, change in saturation measured with pulse oximetry; ΔO2Hbi, change in oxyhemoglobin index; ΔHHbi, change in deoxyhemoglobin index; ΔcHbi, change in total hemoglobin index.

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  Figure 4. Radial-to-femoral pressure gradient and tertile groups of radial artery diameter (RAD). BP, Blood pressure; CPB, cardiopulmonary bypass.

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  Figure 5. Study summary of the prospective study of 278 patients in which a significant radial-to-femoral arterial pressure gradient (RFPG) was observed in 34.8% of all patients and in 48% of those with a radial artery diameter <1.8 mm. In those patients with only a radial artery pressure, increased use of phenylephrine was observed, and in another cohort, the duration of postoperative vasoactive agent use was longer in the intensive care unit. Intra-op, Intra-operative period; Post-op, post-operative period; Rx, medication.

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  Figure E1. (A) Two-dimensional view of the radial artery (B) using color Doppler.

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  Figure E2. Flowchart of patient inclusion.