Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively (P < 0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group (P < 0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P = 0.04). Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery.

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The cardiovascular diseases have top-rated place amongst causes of death all around the world. The leading cardiovascular pathology is coronary artery disease; its course is dependent on severity of atherosclerotic lesion of coronary vessels. Coronary artery bypass grafting (CABG) is one from the most often performed medical techniques of coronary revascularization but has a high risk of perioperative respiratory complications, myocardial infarction, dysrhythmias, kidney dysfunction and other problems. High thoracic epidural anesthesia (HTEA) and analgesia provides sympathetic nerve block of cardiac dermatomes, decreases perioperative stress and pain after CABG, and has a protective role regarding cardiac and respiratory functions. These effects of HTEA are confirmed by a number of studies and systematic reviews. Apart from evident benefits of HTEA, there are restrictions for its use in cardiac surgery associated with increased risk of epidural hematoma followed by neurological consequences. In our review, we describe physiological effects and clinical aspects of using HTEA in coronary surgery.

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