Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery: A retrospective analysis

The maximum rate of pressure rise (dP/dt(max)) in radial artery has been proposed as a noninvasive surrogate of aortic dp/dt(max), reflecting left ventricular (LV) contractility in children. The aim of this study was to investigate relationship between aortic and radial dp/dt(max) at weaning from cardiopulmonary bypass (CPB) and usefulness of these indices for estimating postoperative outcomes in pediatric congenital heart surgery. Aortic and radial arterial pressure waveforms were analyzed simultaneously during weaning from CPB in 29 congenital heart surgery. The maximum first derivatives of aortic and radial arterial waveforms were calculated and averaged from 3 consecutive respiratory cycles. We obtained the maximum vasoactive inotropic score during the first 36 postoperative hours, LV ejection fraction, and fractional shortening on transthoracic echocardiography performed within postoperative day 7. A significant difference between aortic and radial dP/dt(max) was observed (mean difference 356 mm Hg/s, 44% of averages), and radial dP/dt(max) was weakly correlated with aortic dP/dt(max) (r =0.373, P = 0.047). Aortic dP/dt(max) was significantly associated with the maximum vasoactive inotropic score (P < 0.001), postoperative LV ejection fraction (P = 0.018), and fractional shortening (P = 0.015); however, radial dP/dt(max) was not. On Receiver operating characteristic analysis, aortic dP/dt(max) had a greater area under the curve than radial dP/dt(max) in predicting higher vasoactive inotropic score (0.827 vs 0.673). Immediately after CPB in pediatric congenital heart surgery, radial dP/dt(max) may not replace aortic dP/dt(max) because of a discrepancy between central and peripheral arterial waveforms. In this critical period, aortic dP/dt(max) can be useful to estimate postoperative ventricular function rather than peripherally derived dP/dt(max).