Key result
Concurrent pressure field haemodynamic monitoring and TEE prove feasible during pelvic exenteration in severe AR.
Why the study?
Laparoscopic robot-assisted colorectal surgery poses haemodynamic challenges in severe aortic regurgitation, and TOE requires subspecialist skills while providing limited inferences regarding the impact of afterload on myocardial performance.
Case Report (n=1)
Pressure field haemodynamic monitoring can be a useful adjunct to TOE for intraoperative management of patients with severe aortic regurgitation undergoing high-risk laparoscopic surgery.
Feasibility shown in one severe AR case; leaves open whether pressure field monitoring improves TOE-guided care in high-risk surgery.
Laparoscopic robot-assisted colorectal surgery can pose significant haemodynamic challenges for patients with severe aortic regurgitation. The increased afterload caused by pneumoperitoneum and aortic compression, along with concurrent factors like hypercarbia, Trendelenburg positioning and ventilatory impairment, can worsen aortic regurgitation, leading to myocardial ischaemia and heart failure. Transoesophageal echocardiography (TOE) assists haemodynamic management intraoperatively but requires subspecialist skills and enables limited inferences to be drawn regarding the impact of afterload on myocardial performance. Minimally invasive haemodynamic monitoring enabling real-time visualisation of a patient's 'pressure field' has been suggested as a potential adjunct or alternative to TOE, with the added advantage of providing continuous quantitative information about both stroke volume and the afterload to ventricular ejection in a single visualisation. We describe an example of successful concurrent use of pressure field haemodynamic monitoring and TOE in a patient with severe aortic regurgitation having a prolonged laparoscopic robot-assisted pelvic exenteration.
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Martis et al. (2024) conducted a case report in Severe aortic regurgitation (n=1). Pressure field haemodynamic monitoring and transoesophageal echocardiography was evaluated. Pressure field haemodynamic monitoring and transoesophageal echocardiography were successfully used concurrently in 1 patient with severe aortic regurgitation during pelvic exenteration.
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