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Hemodynamic effects of chest closure in adult patients undergoing cardiac surgery.

Abstract：

OBJECTIVE:To evaluate hemodynamic effects of sternal retractor removal and sternal closure after cardiopulmonary bypass and to correlate these changes with preoperative and intraoperative variables. DESIGN:Prospective. SETTING:University hospital. PARTICIPANTS:Fifty adults undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS:Arterial, pulmonary artery, and transesophageal echocardiography measurements were obtained immediately before and 1 minute after removal of the sternal retractor and immediately before and 1 minute after sternal closure. Retractor removal caused a significant decrease in cardiac index by 5.6% (p < 0.01), stroke volume index by 4.0% (p < 0.05), and mean pulmonary artery pressure by 4.8% (p < 0.001). Sternal closure caused a significant decrease in cardiac index by 7.7%, stroke volume index by 10.2%, and left ventricular end-diastolic area by 9.2% (p < 0.001) There were significant increases in pulmonary capillary wedge pressure and systemic vascular resistance by 9.1% and 10.8% (p < 0.01). There was no significant change in the ejection fraction area. The magnitude of decrease in stroke volume index with sternal closure correlated positively with end-diastolic area immediately before the closure. CONCLUSION:Chest closure is associated with significant hemodynamic changes and a change in the ventricular transmural pressure-volume relationship. Patients with lower preload immediately before closure are more vulnerable to a decrease in cardiac index. Based on the results of this study, volume appears to be the appropriate preventive and treatment option to limit the impact of chest closure.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Adsumelli RS,Shapiro JR,Shah PM,Martella AT,Afifi AY,Risher WB,Hicks GL

doi

10.1053/jcan.2001.26537

keywords:

subject

Has Abstract

pub_date

2001-10-01 00:00:00

pages

589-92

issue

5

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(01)01011-4

journal_volume

15

pub_type

杂志文章

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