Radial-to-femoral pressure gradient quantification in cardiac surgery

Vincent Bouchard-Dechêne; Loay Kontar; Pierre Couture; Philippe Pérusse; Sylvie Levesque; Yoan Lamarche; André Y Denault; Montreal Heart Institute Research Team

doi:10.1016/j.xjon.2021.07.031

Radial-to-femoral pressure gradient quantification in cardiac surgery

JTCVS Open. 2021 Aug 5:8:446-460. doi: 10.1016/j.xjon.2021.07.031. eCollection 2021 Dec.

Authors

Vincent Bouchard-Dechêne^{1

2}, Loay Kontar¹, Pierre Couture¹, Philippe Pérusse², Sylvie Levesque³, Yoan Lamarche^{4

5}, André Y Denault^{1

4}; Montreal Heart Institute Research Team

Collaborators

Montreal Heart Institute Research Team:
Antoine Rochon, Alain Deschamps, Georges Desjardins, Nicolas Rousseau-Saine, Jean-Sébastien Lebon, Jennifer Cogan, Marie-Eve Chamberland, Meggie Raymond, Athanase Courbe, Marco Julien, Christian Ayoub, Maria Rosal Martins, William Beaubien-Souligny

Affiliations

¹ Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
² Division of Internal Medicine, Department of Medicine, Hôpital Notre-Dame and Université de Montréal, Montreal, Quebec, Canada.
³ Department of Biostatistics, Montreal Health Innovations Coordinating Centre, Montreal Heart Institute, Montreal, Quebec, Canada.
⁴ Cardiac Surgical Intensive Care Division, Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
⁵ Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.

Abstract

Background: A radial-to-femoral pressure gradient (RFPG) can occur in roughly one-third of cardiac surgical patients. Such a gradient has been associated with smaller stature and potentially smaller radial artery diameter. We hypothesized that preoperative radial artery diameter could be a predictor of RFPG. We also investigated the clinical impact of using a femoral versus a radial arterial catheter in terms of vasoactive support.

Methods: Using ultrasound, we measured the bilateral radial artery diameters of 160 cardiac surgical patients. All arterial pressure values were continuously recorded. Significant RFPG was defined as ≥25 mm Hg in systolic and/or ≥10 mm Hg in mean arterial pressure. One hundred and forty-nine additional patients were used to validate the impact of our observations.

Results: Using 78,013 pressure datapoints in 129 patients, 34.8% of patients had an RFPG with a mean duration of 54 ± 48 minutes. Patients with a radial artery diameter <1.8 mm were more likely to have an RFPG (n = 14 [48.3%] vs 12 [22.2%]; P = .042). Patients with only a radial catheter received more phenylephrine (P = .016) despite undergoing shorter and less complex procedures. In the validation cohort, similar observations were made, and patients with a radial artery catheter received a longer duration of vasoactive support in the intensive care unit.

Conclusions: A significant RFPG occurs in one-third of cardiac surgical patients and in 48% of those with a radial artery diameter <1.8 mm. The use of a single radial arterial catheter instead of dual radial and femoral catheters was associated with greater vasopressor requirements in the operating room and in the intensive care unit. We do not recommend the use of a single radial artery catheter in cardiac surgery.

Keywords: BMI, body mass index; BSA, body surface area; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; ICU, intensive care unit; IQR, interquartile range; RFPG, radial-to-femoral pressure gradient; cardiac surgery; femoral arterial pressure; radial arterial pressure; radial-to-femoral arterial pressure gradient; vasoactive support.