Application of transesophageal echocardiography combined with FloTrac monitoring in cardiac valve replacement surgery

TL;DR

This study compares two monitoring methods during heart valve surgery and finds differences in hemodynamic measurements but not in postoperative cognitive issues.

Contribution

The study introduces a novel comparison of TEE with FloTrac versus invasive monitoring in valve surgery, revealing distinct hemodynamic trends.

Findings

TEE combined with FloTrac showed significant group differences in heart rate, cardiac output, and stroke volume variation.

Temporal interactions in hemodynamic parameters were observed but did not affect postoperative cognitive dysfunction rates.

Nominal associations between specific hemodynamic metrics and POCD were found but lacked strong predictive value.

Abstract

To compare intraoperative hemodynamics between transesophageal echocardiography (TEE) combined with FloTrac vs. TEE with invasive arterial pressure monitoring, and to examine associations with postoperative cognitive dysfunction (POCD) in patients undergoing cardiac valve replacement.

A retrospective matched-cohort study included 162 patients (81 per group) matched by surgical type, ASA classification, age, and cardiopulmonary bypass time. Hemodynamic parameters were measured at four time points (T1–T4). Linear mixed-effects models assessed group, time, and interaction effects. Exploratory logistic regression preserving the matched design evaluated associations with POCD.

Group effects were significant for heart rate (HR, F = 6.79, p = 0.009), cardiac output (CO, F = 17.05, p < 0.001), cardiac index (CI, F = 16.49, p < 0.001), and stroke volume variation (SVV, F = 18.73, p < 0.001). Group × time interactions were observed for MAP, CVP, HR, SV, CI, SVRI, SVV, VTI, and LVEDV (all p < 0.05). Pearson correlations at T3 were weak (SV vs. CI r = 0.274; FAC vs. SVRI r = −0.220). Postoperative complication rates, including POCD (9.9% vs. 18.5%, OR = 0.48, 95% CI: 0.19–1.21, p = 0.115), were not significantly different. HR at T2 and SVRI at T4 showed nominal associations with POCD, but predictive ability was limited.

TEE combined with FloTrac provides a more detailed intraoperative hemodynamic assessment and reveals distinct temporal trends compared to invasive arterial pressure monitoring. These differences did not correspond to changes in clinical outcomes in this cohort, but the observations may inform the design of future studies on hemodynamic monitoring strategies and POCD risk.

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