Carsten Riedel

Dynamic device properties of pulse contour cardiac output during transcatheter aortic valve implantation

This prospective single-center study aimed to determine the responsiveness and diagnostic performance of continuous cardiac output (CCO) monitors based on pulse contour analysis compared with invasive mean arterial pressure (MAP) during predefined periods of acute circulatory deterioration in patients undergoing transcatheter aortic valve implantation (TAVI). The ability of calibrated (CCOCAL) and self-calibrated (CCOAUTOCAL) pulse contour analysis to detect the hemodynamic response to 37 episodes of balloon aortic valvuloplasty enabled by rapid ventricular pacing was quantified in 13 patients undergoing TAVI. A “low” and a “high” cut-off limit were predefined as a 15 or 25 % decrease from baseline respectively. We found no significant differences between CCOCAL and MAP regarding mean response time [low cut-off: 8.6 (7.1–10.5) vs. 8.9 (7.3–10.8) s, p = 0.76; high cut-off: 11.4 (9.7–13.5) vs. 12.6 (10.7–14.9) s, p = 0.32] or diagnostic performance [area under the receiver operating characteristics curve (AUC): 0.99 (0.98–1.0) vs. 1.0 (0.99–1.0), p = 0.46]. But CCOCAL had a significantly higher amplitude response [95.0 (88.7–98.8) % decrease from baseline] than MAP [41.2 (30.0–52.9) %, p < 0.001]. CCOAUTOCAL had a significantly lower AUC [0.83 (0.73–0.93), p < 0.001] than MAP. Moreover, CCOCAL detected hemodynamic recovery significantly earlier than MAP. In conclusion, CCOCAL and MAP provided equivalent responsiveness and diagnostic performance to detect acute circulatory depression, whereas CCOAUTOCAL appeared to be less appropriate. In contrast to CCOCAL the amplitude response of MAP was poor. Consequently even small response amplitudes of MAP could indicate severe decreases in CO.