Right heart catheterization does not reduce cardiac risks of noncardiac surgery

המידע באדיבות אתר מדיקונטקסט:By Anthony J. Brown, MD

WESTPORT, CT (Reuters Health) – Perioperative right heart catheterization (RHC) does not reduce the risk of major cardiac events that can occur after high-risk noncardiac surgery, according to a report published in the July 18th issue of The Journal of the American Medical Association.

Dr. Thomas H. Lee, from Brigham and Women's Hospital, Harvard Medical School, in Boston, and colleagues assessed the postoperative cardiac and noncardiac outcomes of 4059 patients who underwent a major elective noncardiac procedure with an expected length of stay of at least 2 days. Of the group, 221 subjects had undergone a perioperative RHC.

Major cardiac events occurred in 4.2% of subjects, the authors note. RHC patients showed a threefold increase in the incidence of major postoperative cardiac events. A smaller case-control analysis of 215 matched pairs of patients revealed that RHC patients were more likely to develop postoperative congestive heart failure and major noncardiac events than uncatheterized patients.

"I don't believe that the catheters caused the increase in the complication rate," Dr. Lee told Reuters Health. "It is extremely likely that the patients who received the catheters were sicker than the patients who didn't," he explained. "However, the results do seem to suggest that catheters are being used in much broader populations than are likely to benefit."

"There are almost surely subsets of patients who are better off undergoing an RHC, but we don't know what these subsets are," Dr. Lee stated. "It is a very common procedure that has some risks, and we probably should be doing some randomized studies to see exactly who does benefit from RHC."

In an editorial, Dr. James E. Dalen, from the University of Arizona Health Sciences Center in Tucson, comments that "despite more than 30 years' experience with the pulmonary artery catheter (PAC), little evidence exists in the medical literature to demonstrate a benefit associated with use of the PAC in critically ill or perioperative patients."

Dr. Dalen advises that "given the fact that PAC placement is invasive, has potentially fatal complications, and is expensive, this procedure is not indicated for routine monitoring of patients undergoing major surgery or in patients with acute myocardial infarction."

JAMA 2001;286:309-314,348-350.

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