Invasive and noninvasive cardiovascular monitoring options for cardiac surgery

Heart disease is the most common cause of death in the United States, with more than 655,000 deaths in the 2018 Centers for Disease Control and Prevention report. Surgical treatment of heart disease is common, expensive, and greater risk than many other surgical endeavors. Cardiovascular monitoring is an important process within this complex clinical setting that requires careful consideration of the patient and the clinical team, as well as the institutional resources to optimize a precise and personalized approach. A comprehensive evaluation of monitoring must consider patient anatomy and cardiopulmonary physiology, hemodynamic and physiologic goals, the phases of care, direct and indirect costs, and operational considerations such as duration of monitoring, therapeutic protocols, and team expertise. Invasive monitoring is a universally accepted component of cardiac surgical perioperative care, but there remain unresolved controversies as to the optimal monitoring strategies to optimize efficacy and efficiency. One of the long-standing controversies is the use of a pulmonary artery catheter (PAC) versus other monitoring alternatives (Figure