Association of pulmonary artery systolic pressure measured by transesophageal echocardiography with early postoperative morbidity in patients undergoing elective on-pump coronary artery bypass grafting

Abstract

Background & objective: Coronary artery disease (CAD) significantly impacts patients’ life and the surgical outcomes, necessitating effective preoperative risk assessment. Pulmonary artery systolic pressure (PASP) measured intraoperatively via transesophageal echocardiography (TEE) may serve as a critical indicator of postoperative complications in elective on-pump coronary artery bypass grafting (CABG).

We aimed to evaluate the association between elevated intraoperative PASP and postoperative early complications in patients undergoing elective on-pump CABG.

Methodology: This study involved 70 patients undergoing elective on-pump CABG, divided into two groups, based on intraoperative PASP measured using TEE: Group A: 35 patients with PASP ≥ 35 mmHg. Group B: 35 patients with PASP < 35 mmHg. The study analyzed PASP association with early postoperative complications, including respiratory failure, significant inotrope use, intra-aortic balloon pump (IABP) use, prolonged ICU stay (> 48 hours), and extended hospital stay (> 7 days).

Results: Postoperative respiratory failure (P < 0.009), significant inotrope use (P < 0.001), IABP use (P < 0.023), prolonged ICU stay (> 48 hours) (P < 0.001), and extended hospital stay (> 7 days) (P < 0.001) were significantly higher in Group A. No statistically significant differences between groups regarding postoperative anticoagulation, pacemaker dependence, arrhythmias, or myocardial infarction were noted (P = 0.145, 0.164, 0.55, and 0.743, respectively). When comparing PASP grades: severe PASP was associated with higher rates of postoperative respiratory failure, IABP use, prolonged ICU stays, and total hospital stays (P = 0.03, 0.01, 0.01, and < 0.001, respectively). Moderate pulmonary hypertension was associated with the most frequent use of significant inotropes (P = 0.03). No significant differences in postoperative anticoagulation, arrhythmias, myocardial infarction, or pacemaker dependence (P = 0.21, 0.87, 0.84, and 0.19, respectively) was noted.

Conclusion: Intraoperative PASP measurement using TEE is a valuable predictor of early postoperative complications and events in patients undergoing elective on-pump CABG.

Abbreviations: IAPB: intra-aortic balloon pump, IBP: invasive blood pressure, ICU: Intensive care unit, CABG: coronary artery bypass grafting, CAD: Coronary artery disease, PAH: Pulmonary arterial hypertension, PASP: Pulmonary artery systolic pressure, RAP: right atrial pressure, RHC: right heart catheterization, TEE: transesophageal echocardiography

Keywords: Pulmonary artery systolic pressure (PASP), Transesophageal echocardiography (TEE), On-pump coronary artery bypass graft (CABG).

Citation: Mohamed AMF, Nasr NS, Amin SOE, Mohamed AMM. Association of pulmonary artery systolic pressure measured by transesophageal echocardiography with early postoperative morbidity in patients undergoing elective on-pump coronary artery bypass grafting. Anaesth. pain intensive care 2025;29(5):317-327. DOI: 10.35975/apic.v29i5.2856

Received: March 24, 2025; Revised: April 18, 2025; Accepted: May 21, 2025