PREOPERATIVE OPTIMIZATION OF CARDIOVASCULAR HEMODYNAMICS IMPROVES OUTCOME IN PERIPHERAL VASCULAR-SURGERY - A PROSPECTIVE, RANDOMIZED CLINICAL-TRIAL

The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested. Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or the preinduction room (group 2) or to control (group 3). The tune-up consisted of fluid loading, afterload reduction, and/or inotropic support to achieve predetermined endpoints. Patients with a PA catheter had significantly fewer adverse intraoperative events (p < 0.05), less postoperative cardiac morbidity (p < 0.05), and less early graft thrombosis (p < 0.05) than the control group. The overall study mortality rate was 3.4%, with a mortality rate of 9.5% in the control group and 1.5% in the PA catheter groups. There were no differences in ICU length of stay (LOS), hospital LOS, or total hospital costs, although the percentage of cost from complications was higher in group 3 (p > 0.05). In this group of patients, preoperative cardiac assessment and optimization is associated with improved outcome.