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Validation of cardiac output estimation using the fourth-generation FloTrac/EV1000™ system in patients undergoing robotic-assisted off-pump coronary artery bypass surgery

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Abstract

The pulmonary artery catheter (PAC)—despite its invasiveness—remains the gold standard for cardiac output (CO) monitoring. The FloTrac system, a less invasive hemodynamic monitor has been developed, which estimates CO using arterial pressure waveform analysis without external calibration. Recently, an upgraded version of FloTrac system with improved algorithm to follow changes in vascular resistance was introduced into the market. The aim of this study was to assess the reliability of the CO estimated from the fourth-generation FloTrac/EV1000 system (COFT) compared to that measured with PAC using the thermodilution method (COPAC) during robotic-assisted off-pump coronary artery bypass (OPCAB) surgery. COFT and COPAC were obtained simultaneously at 4 predefined time points during robotic-assisted OPCAB: 5 min after the induction of general anesthesia (T1), after starting one-lung ventilation (T2), after capnothorax (T3), and after mini-thoracotomy was performed (T4). The agreement of data was investigated by Bland–Altman analysis. Thirty-four patients were initially enrolled. After exclusion, 32 patients and a total of 128 paired CO measurements were obtained. The overall bias was 1.46 L/min, the 95% limits of agreements were − 3.40 to 6.33 L/min, and the percentage error was 72.98%. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between COPAC and COFT showed that the bias was moderately correlated with the SVRI (r2 = 0.43; p < 0.0001). Despite a software upgrade, the reliability of the fourth-generation FloTrac/EV1000™ system during robotic-assisted OPCAB to estimate CO was not acceptable, especially in patients with low SVRI.

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Acknowledgements

We offer special thanks to Dr. Shu-Wei Wang and Yung-Chu Teng for their excellent assistance in writing and revising the draft of this manuscript. We also express our gratitude to Prof. Yen Chang and Dr. Chung-Yu Lo who performed the surgery and cared for the patients in this study. This article was edited by American Journal Experts (AJE).

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Author notes

  1. Han-Yu Lin and Ming‐Chang Kao contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Rd., Sindian District, New Taipei City, 23142, Taiwan

    Nien-Hsun Wu, Chun-Yu Chang, Ping-Chen Shih & Han-Yu Lin

  2. Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan

    Tsung-Han Hsieh

  3. School of Medicine, Tzu Chi University, Hualien, Taiwan

    Han-Yu Lin

  4. Department of Anesthesiology, New Taipei Municipal TuCheng Hospital (Built and Operated By Chang Gung Medical Foundation), New Taipei City, Taiwan

    Ming‐Chang Kao

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  1. Nien-Hsun Wu
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  2. Tsung-Han Hsieh
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  3. Chun-Yu Chang
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  4. Ping-Chen Shih
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Correspondence to Han-Yu Lin.

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The authors declare that they have no conflict of interest.

Ethics approval

Approval was obtained from the Institutional Review Board of Taipei Tzu Chi Hospital (IRB No.10-XD-005). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Wu, NH., Hsieh, TH., Chang, CY. et al. Validation of cardiac output estimation using the fourth-generation FloTrac/EV1000™ system in patients undergoing robotic-assisted off-pump coronary artery bypass surgery. Heart Vessels 38, 341–347 (2023). https://doi.org/10.1007/s00380-022-02177-x

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  • DOI: https://doi.org/10.1007/s00380-022-02177-x

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