Background: Noninvasive cardiac output (CO) measured using ClearSight™ eliminates the need for intra-arterial catheter insertion. The purpose of this study was to examine the accuracy of non-invasive CO measurement in patients with severe aortic valve stenosis (AS). Methods: Twenty-eight patients undergoing elective transcatheter aortic valve implantation were prospectively enrolled in this study. The CO was simultaneously measured twice before and twice after valve deployment (total of four times) per patient, and the CO was compared between the ClearSight (COClearSight) system and the pulmonary artery catheter (PAC) thermodilution (COTD) method as a reference. The Bland-Altman analysis was used to compare the percentage errors between the methods. Results: A total of 112 paired data points were obtained. The percentage error between the COClearSight and COTD was 43.1%. The paired datasets were divided into the following groups according to the systemic vascular resistance index (SVRI): low (< 1,200 dyne s/cm5/m2) and normal (1,200–2,500 dyne s/cm5/m2). The percentage errors were 44.9% and 49.4%, respectively. The discrepancy of CO between COClearSight and COTD was not significantly correlated with SVRI (r = −0.06, P < 0.001). The polar plot analysis showed the trending ability of the COClearSight after artificial valve deployment was 51.1% which below the acceptable cut-off (92%). Conclusions: The accuracy and the trending ability of the ClearSight CO measurements were not acceptable in patients with severe AS. Therefore, the ClearSight system is not interchangeable with the PAC thermodilution for determining CO in this population.
Purpose: The accuracy of ClearSightTM blood pressure measurements in patients with postaortic valve replacement may be inaccurate compared to intra-arterial pressure, the clinical risk of measurement discrepancy remains uncertain. This study aimed to determine the factors associated with errors in measurement. Methods: From October 2020 to November 2021, we collected 881 pairs of intra-arterial/ClearSight blood pressure measurements from 30 adults who underwent transcatheter aortic valve replacement. The agreement of ClearSight blood pressure with intra-arterial pressure was compared, and the clinical risk was evaluated by classifying measurement errors into zones A (no risk) to E (dangerous risk) using error grid analysis. Results: The bias and precision of ClearSight measurement were −4.88 ± 15.46 (mmHg) for systolic, 4.73 ± 8.95 (mmHg) for the mean and 9.53 ± 9.01 (mmHg) for the diastolic blood pressure. The proportions of measurement pairs in zones A were 88.0% for systolic BP and 71.2% for mean BP, respectively. Logistic regression analysis revealed that the risk of measurement error being outside zone A was heart rate [odds ratio, 1.24; 95% confidence interval, 1.15 to 1.35; p<0.001] for systolic and mean blood pressure, and aortic valve area index < 1.0 (cm2. m−2) [odds ratio, 1.62; 95% confidence interval, 1.21 to 2.16; p=0.02] for mean blood pressure.Conclusion: These findings could help to identify patients of unsuitable for ClearSight blood pressure measurement. Our results demonstrate that the small aortic valve area index and low cardiac index are risk factors for measurement error.
We had a case in which a transesophageal echocardiography (TEE) probe migrated into the anterior mediastinum. The patient was a 62-year-old woman who had undergone mitral valve replacement (MVR) for infectious endcarditis. The procedure was successfully finished. The TEE was inserted without any complications before the surgery and removed at the end of the surgery. However, postoperative bleeding from the ascending aorta was found after the MVR, and an emergency operation for hemostasis was performed. After the hemostatic procedure was completed, we inserted a TEE probe to examine whether aortic dissection had occurred. Insertion of the TEE probe was so difficult that the probe was inserted after a few tries. However, we found that the probe migrated into the anterior mediastinum while TEE was progressing. The oropharynx was perforated, and an operation to close it had to be performed. We considered several possible causes of the perforation. First, the operation was performed in an emergency situation and drapes were covering the patient's face at the time of TEE insertion. Second, the patient had been taking prednisolone over a long period of time which made her tissues fragile.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.