Key result
Aortic unclamping increased the Cardiac Power Index from a basal 0.39 W/m2 to 0.44 W/m2 during open aortic surgery.
Why the study?
Aortic clamping and unclamping expose the heart to abrupt hemodynamic variations, but how these procedures affect the Cardiac Power Index during open aortic surgery was unknown.
Does aortic cross-clamping and unclamping affect the Cardiac Power Index in patients undergoing open surgical aortic repair?
Observational (n=67)
No
Does aortic cross-clamping and unclamping affect the Cardiac Power Index in patients undergoing open surgical aortic repair?
Answers are grounded in this paper and cite their sources.
The Cardiac Power Index significantly increases after aortic unclamping during open aortic surgery and may help predict intraoperative cardiac impairment.
Background: The Cardiac Power Index (CPI) measures the rate of energy output generated by the heart and correlates this with in-hospital mortality due to cardiogenic shock. In open aortic surgery, both aortic clamping and unclamping expose the heart to abrupt variations of the left ventricle afterload, preload, and contractility, with possible hemodynamic impairment. We investigated how aortic-cross clamping (Ao-XC) and unclamping (Ao-UC) procedures affect the CPI during open aortic surgery. Methods: We retrospectively analyzed our surgical database of 67 patients submitted to open surgical aortic repair at Humanitas Research Hospital, Milan. Patients were monitored by an EV1000-FloTrac SystemTM (Edwards Lifescience, Irvine, CA, USA) beyond the standard intra-operative hemodynamic monitoring. The primary outcome was the variation of basal CPI after aortic clamping and unclamping. Secondary outcomes were variations of the cardiac index (CI), mean arterial pressure (MAP), heart rate, and lactate during aortic clamping and after unclamping. The CPI was computed as: (CI × MAP)/451. Results: The CPI changed significantly after aortic unclamping. CPI: basal = 0.39 ± 0.1 W/m2, after Ao-XC = 0.39 ± 0.1 W/m2, and after Ao-UC = 0.44 ± 0.2 W/m2, p < 0.05. The CI changed during both cross-clamping and unclamping (p < 0.0001), whilst the MAP and heart rate did not during any phase of the surgery. Five subjects (8.3%) needed inotropic support after cross-clamping. Their basal CPI was lower than the general population: 0.31 ± 0.11 W/m2 vs. 0.39 ± 0.1 W/m2. Conclusions: The CPI describes the adaptation of the cardiac function to the changes in preload, contractility, and afterload occurring during aortic cross-clamping and unclamping. It may be used to explore the cardiac performance in real-time and predict cardiac impairment in the intraoperative period in a minimally invasive way, similar to ventriculo-arterial coupling parameters.
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Nisi et al. (2022) conducted an observational in Open surgical aortic repair (n=67). Aortic cross-clamping and unclamping vs. Basal state was evaluated on Variation of basal Cardiac Power Index (CPI) after aortic clamping and unclamping (p=<0.05). Aortic unclamping increased the Cardiac Power Index from a basal 0.39 W/m2 to 0.44 W/m2 during open aortic surgery.
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