Perioperative Treatment of Adult Congenital Heart Disease by PiCCO Technique: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENGYan-hai ¹ , ZHANGYan-bo ¹ , YANGKe-ming ² , LIULing-feng ¹ , HANGHai-bo ¹ , CHANGShuo ¹ , SHIChen ¹ , ZHANGRong-yuan ¹ , YANGQiu-lan ¹ , LIUZi-na ¹

1. Department of Cardiovascular Surgery ICU, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;
2. Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

Keywords：

Pulse indicator continuous cardiac output; Adult congenital heart disease; Randomized controlled trial

DOI：

10.7507/1007-4848.20160228

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Objective To evaluate the application value and significance of pulse indicator continuous cardiac output (PiCCO) in perioperative treatment of adult congenital heart disease (ACHD). Methods Between June 2014 and June 2015, 100 adult patients (44 females and 56 males) underwent congenital heart disease operation. Patients were randomly divided into a PiCCO group and an experience treatment (control) group. According to the data of PiCCO detection, the PiCCO group was treated with vasoactive drugs and liquid balance management, the control group was treated by routine monitoring data. The clinical effectiveness of the two groups was compared. Results The ventilator time, ICU time and length of stay in the PiCCO group were significantly shorter than those in the control group with statistical differences (P=0.02, 0.03, 0.04). The drug dosage (dopamine, milrinone) during ICU were higher in the PiCCO group than those in the control group (P<0.01, P=0.04). There was no mortality in both groups. No significant difference was found in the incidence of postoperative complications between the two groups (P>0.05). Conclusion The application of PiCCO in the perioperative treatment of adult congenital heart disease can promote the early recovery of ACHD patients, and has a certain safety and effectiveness. Actively vasoactive drugs application to maintain circulation early in ICU has positive effect on the patient's recovery.

Citation： MENG Yan-hai, ZHANG Yan-bo, YANG Ke-ming, LIU Ling-feng, HANG Hai-bo, CHANG Shuo, SHI Chen, ZHANG Rong-yuan, YANG Qiu-lan, LIU Zi-na. Perioperative Treatment of Adult Congenital Heart Disease by PiCCO Technique: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 949-953. doi: 10.7507/1007-4848.20160228 Copy

1.	Fernandes SM, Chamberlain LJ, Grady S Jr, et al. Trends in utilization of specialty care centers in California for adults with congenital heart disease. Am J Cardiol, 2015, 115(9): 1298-1304.
2.	Bhatt AB, Foster E, Kuehl K, et al. Congenital heart disease in the older adult: a scientific statement from the American Heart Association. Circulation, 2015, 131(21): 1884-1931.
3.	Madan P, Kim YY. Training in adult congenital heart disease. J Am Coll Cardiol, 2015, 65(20): 2254-2256.
4.	张怀军, 许建屏, 宋云虎. 成人Ebstein's畸形的临床特征及外科治疗策略. 中国胸心血管外科临床杂志, 2014, 21(4): 465-467.
5.	Vouhe PR. Adult congenital surgery: current management. Semin Thorac Cardiovasc Surg, 2011, 23(3): 209-215.
6.	6 Gilly H, Schlöglhofer T, Schima H. Semi-invasive cardiac output measurement based on pulse contour: a review. Biomed Tech (Berl). 2013 Sep 7. pii: /j/bmte.2013.58.issue-s1-I/bmt-2013-4221/bmt-2013-4221.xml. doi: 10.1515/bmt-2013-4221.[Epubaheadofprint.
7.	Litton E, Morgan M. The PiCCO monitor: a review. Anaesth Intensive Care, 2012, 40(3): 393-409.
8.	Zhang Z, Ni H, Qian Z. Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med, 2015, 41(3): 444-451.
9.	Hays L. Transition to adult congenital heart disease care: a review. J Pediatr Nurs, 2015, 30(5): e63-e69.
10.	Avila P, Mercier LA, Dore A, et al. Adult congenital heart disease: a growing epidemic. Can J Cardiol, 2014, 30(12 Suppl): S410-S419.
11.	徐朝军, 宋岚, 尹晓清, 等. 改良B-T分流术在肺血减少型先天性心脏病中的临床应用. 中国胸心血管外科临床杂志, 2015, 22(5): 450-453.
12.	Chen G, Zuo Y, Yang L, et al. Hemodynamic monitoring and management of patients undergoing high-risk surgery: a survey among Chinese anesthesiologists. J Biomed Res, 2014, 28(5): 376-382.
13.	Cannesson M, Pestel G, Ricks C, et al. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care, 2011, 15(4): R197.
14.	Greenberg SB, Murphy GS, Vender JS. Current use of the pulmonary artery catheter. Curr Opin Crit Care, 2009, 15(3): 249-253.
15.	Lenkin AI, Kirov MY, Kuzkov VV, et al. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Crit Care Res Pract, 2012, 2012: 821218.
16.	Schloglhofer T, Gilly H, Schima H. Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis. Can J Anaesth, 2014, 61(5): 452-479.
17.	Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothorac Vasc Anesth, 2013, 27(1): 121-134.
18.	Sami A, Sami A, Rochdil N, et al. PiCCO monitoring accuracy in low body temperature. Am J Emerg Med, 2007, 25(7): 845-846.
19.	刘子娜, 张燕搏. 脉搏指示连续心输出量监测技术应用原理及临床意义研究进展. 中华实用诊断与治疗杂志, 2015, 29(5): 417-419.
20.	Smetkin AA, Hussain A, Kuzkov VV, et al. Validation of cardiac output monitoring based on uncalibrated pulse contour analysis vs transpulmonary thermodilution during off-pump coronary artery bypass grafting. Br J Anaesth, 2014, 112(6): 1024-1031.
21.	汪洋, 郑萍, 祁明. PiCCO技术对复杂先天性心脏病患儿围手术期治疗的意义. 心脏杂志, 2013, 5: 579-581.

1. Fernandes SM, Chamberlain LJ, Grady S Jr, et al. Trends in utilization of specialty care centers in California for adults with congenital heart disease. Am J Cardiol, 2015, 115(9): 1298-1304.
2. Bhatt AB, Foster E, Kuehl K, et al. Congenital heart disease in the older adult: a scientific statement from the American Heart Association. Circulation, 2015, 131(21): 1884-1931.
3. Madan P, Kim YY. Training in adult congenital heart disease. J Am Coll Cardiol, 2015, 65(20): 2254-2256.
4. 张怀军, 许建屏, 宋云虎. 成人Ebstein's畸形的临床特征及外科治疗策略. 中国胸心血管外科临床杂志, 2014, 21(4): 465-467.
5. Vouhe PR. Adult congenital surgery: current management. Semin Thorac Cardiovasc Surg, 2011, 23(3): 209-215.
6. 6 Gilly H, Schlöglhofer T, Schima H. Semi-invasive cardiac output measurement based on pulse contour: a review. Biomed Tech (Berl). 2013 Sep 7. pii: /j/bmte.2013.58.issue-s1-I/bmt-2013-4221/bmt-2013-4221.xml. doi: 10.1515/bmt-2013-4221.[Epubaheadofprint.
7. Litton E, Morgan M. The PiCCO monitor: a review. Anaesth Intensive Care, 2012, 40(3): 393-409.
8. Zhang Z, Ni H, Qian Z. Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med, 2015, 41(3): 444-451.
9. Hays L. Transition to adult congenital heart disease care: a review. J Pediatr Nurs, 2015, 30(5): e63-e69.
10. Avila P, Mercier LA, Dore A, et al. Adult congenital heart disease: a growing epidemic. Can J Cardiol, 2014, 30(12 Suppl): S410-S419.
11. 徐朝军, 宋岚, 尹晓清, 等. 改良B-T分流术在肺血减少型先天性心脏病中的临床应用. 中国胸心血管外科临床杂志, 2015, 22(5): 450-453.
12. Chen G, Zuo Y, Yang L, et al. Hemodynamic monitoring and management of patients undergoing high-risk surgery: a survey among Chinese anesthesiologists. J Biomed Res, 2014, 28(5): 376-382.
13. Cannesson M, Pestel G, Ricks C, et al. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care, 2011, 15(4): R197.
14. Greenberg SB, Murphy GS, Vender JS. Current use of the pulmonary artery catheter. Curr Opin Crit Care, 2009, 15(3): 249-253.
15. Lenkin AI, Kirov MY, Kuzkov VV, et al. Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Crit Care Res Pract, 2012, 2012: 821218.
16. Schloglhofer T, Gilly H, Schima H. Semi-invasive measurement of cardiac output based on pulse contour: a review and analysis. Can J Anaesth, 2014, 61(5): 452-479.
17. Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothorac Vasc Anesth, 2013, 27(1): 121-134.
18. Sami A, Sami A, Rochdil N, et al. PiCCO monitoring accuracy in low body temperature. Am J Emerg Med, 2007, 25(7): 845-846.
19. 刘子娜, 张燕搏. 脉搏指示连续心输出量监测技术应用原理及临床意义研究进展. 中华实用诊断与治疗杂志, 2015, 29(5): 417-419.
20. Smetkin AA, Hussain A, Kuzkov VV, et al. Validation of cardiac output monitoring based on uncalibrated pulse contour analysis vs transpulmonary thermodilution during off-pump coronary artery bypass grafting. Br J Anaesth, 2014, 112(6): 1024-1031.
21. 汪洋, 郑萍, 祁明. PiCCO技术对复杂先天性心脏病患儿围手术期治疗的意义. 心脏杂志, 2013, 5: 579-581.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative Treatment of Adult Congenital Heart Disease by PiCCO Technique: A Randomized Controlled Trial

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