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IMPACT OF ADVANCED HEMODYNAMIC MONITORING ON
MYOCARDIAL REVASCULARIZATION SURGERY IN HIGH-RISK
PATIENTS
Henrique Djosci Coêlho de Sá1
Vinicius Costa de Mello Farah2
Lucca Fernandes Alevato3
Thiago Zanetti Pinheiro4
Paulo Víctor Elias Sobrinho5
José Sérgio Martins Neto6
Paulo Andre Ramalho Rangel Lima7
Eduardo Bandeira de Mello Sanches de Almeida8
Vitor Hugo Mendes da Cunha9
Antônio Vitor Gullo de Oliveira Ribeiro10
Luiza Tibério Campos Calegário11
Abstract: Coronary artery bypass grafting is a critical procedure for patients with advanced coronary
disease, especially those classied as high risk due to comorbidities such as heart failure, hypertension
and diabetes. Advanced hemodynamic monitoring has proved essential in this context, allowing
1 University of Gurupi
2 Souza Marques College
3 Souza Marques College
4 Iguaçu Campos V University (UNIG)
5 Universidad Sudamericana
6 Souza Marques College
7 Souza Marques College
8 Souza Marques College
9 Souza Marques College
10 Souza Marques College
11 Vila Velha University
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continuous and accurate surveillance of cardiac and vascular parameters, which can reduce intra-
and post-operative complications. This abstract aims to assess the impact of advanced hemodynamic
monitoring during coronary artery bypass graft surgery in high-risk patients. The aim is to explore
the advantages of this type of monitoring, the technologies used and the benets in terms of clinical
outcomes and reduction of complications. This is a literature review with a qualitative approach, carried
out in the PubMed, SciELO, LILACS, BVS and Google Scholar databases. In order to optimize the
search, descriptors such as Hemodynamic Monitoring, Cardiac Surgery, High Risk Patients and Fluid
Management were used. For time delimitation, the research considered publications between the years
2019 and 2022, a period that reects the latest advances in hemodynamic monitoring technologies in
high-risk cardiac surgeries. Advanced hemodynamic monitoring includes the use of devices such as
the pulmonary artery catheter and non-invasive bioimpedance systems, which provide real-time data
on cardiac output, blood pressure, oxygen saturation and systemic vascular resistance. In high-risk
patients, these devices allow for precise adjustments in the administration of uids and vasoactive drugs,
promoting better hemodynamic stability. Studies indicate that this approach reduces the incidence of
serious complications, such as cardiogenic shock and arrhythmias, optimizing post-operative recovery.
Therefore, advanced hemodynamic monitoring is a crucial tool in CABG surgeries, especially for high-
risk patients. Its implementation improves intraoperative management, reducing the risk of complications
and promoting better clinical outcomes. Therefore, its use should be considered an integral part of
strategies for complex cardiac surgeries.
Keywords: General Surgery, Revascularization; Hemodynamics; Cardiology.
INTRODUCTION
Coronary artery bypass grafting (CABG) surgery is widely used in the treatment of patients
with coronary artery disease, especially those with multiple vessels compromised and in advanced
stages of the disease. However, when performed in high-risk patients, such as the elderly or patients with
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severe comorbidities, CABG presents signicant challenges in terms of safety and efcacy. In these
cases, advanced hemodynamic monitoring has been identied as a crucial strategy for intraoperative
and postoperative management, allowing for more precise management of tissue perfusion, cardiac
function, and circulatory parameters (SOUZA et al., 2020).
Advanced hemodynamic monitoring involves the use of technologies that allow continuous
evaluation of critical parameters such as cardiac output, central venous pressure, venous oxygen
saturation, and systemic vascular resistance. This information is essential to guide precise therapeutic
interventions, especially in highly complex surgeries such as CABG, where abrupt variations in
circulatory parameters can lead to serious complications, such as cardiogenic shock, ventricular
dysfunction, and multiorgan failure (COSTA, 2021).
In high-risk patients undergoing CABG, advanced hemodynamic monitoring has been
associated with a reduction in perioperative complications and an improvement in clinical outcomes.
Studies have shown that, by allowing early intervention in the face of changes in hemodynamic
parameters, this monitoring can reduce mortality, length of hospital stay, and the need for prolonged
vasopressor and ventilatory support. In addition, continuous monitoring allows for a more detailed
assessment of the response to uid and vasoactive drug therapy, crucial for maintaining hemodynamic
stability in patients with severe cardiac dysfunction (PEREIRA et al., 2022).
Despite the widely recognized benets, the implementation of advanced hemodynamic
monitoring still faces challenges, such as the high cost of devices and the need for specialized training
for surgical and critical care staff. However, in high-risk patients, the cost-benet tends to be favorable,
considering the potential reduction of serious complications and the shorter postoperative recovery
time. With the advancement of monitoring technologies and the expansion of access to these resources,
it is expected that the use of advanced hemodynamic monitoring will become increasingly widespread,
especially in highly complex surgeries, such as CABG (SANTOS et al., 2021).
This study aims to evaluate the impact of advanced hemodynamic monitoring during coronary
artery bypass grafting in high-risk patients. It is intended to explore the advantages of this type of
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monitoring, the technologies used and the benets in terms of clinical outcomes and reduction of
complications.
MATERIALS AND METHODS
This is a literature review with a qualitative approach, carried out in the PubMed, SciELO,
LILACS, BVS and Google Scholar databases. In order to optimize the search, descriptors such as
“Hemodynamic Monitoring”, “Cardiac Surgeries”, “High-Risk Patients” and “Fluid Management”
were used. For the temporal delimitation, the research considered publications between the years 2019
and 2022, a period that reects the most recent advances in hemodynamic monitoring technologies in
high-risk cardiac surgeries.
Inclusion Criteria:
Articles published between 2019 and 2022, considering recent technological advances.
Studies that address hemodynamic monitoring in cardiac surgeries, focusing on high-risk
patients.
Publications in English or Portuguese, accessible in full text.
Studies that discuss clinical outcomes related to the use of advanced monitoring technologies.
Systematic review studies, observational surveys, and clinical trials that include innovative
therapies and intraoperative monitoring.
Exclusion Criteria:
Articles published before 2019, due to continuous technological evolution.
Studies that exclusively address pediatric patients or noncardiac surgeries.
Studies without evaluation of clinical benets or that deal with hemodynamic monitoring in a
supercial way.
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Reviews without methodological rigor or opinion articles.
The research seeks to answer the following guiding question: What are the clinical advances
and benets of hemodynamic monitoring in high-risk cardiac surgeries between 2019 and 2022.
THEORETICAL FOUNDATION
Advanced hemodynamic monitoring is an essential resource for the management of patients
undergoing coronary artery bypass grafting, particularly those classied as high-risk. These patients,
often affected by comorbidities, such as heart failure, systemic arterial hypertension and diabetes, have
a more complex physiological response during and after surgery, requiring strict control of circulatory
parameters to avoid serious complications. Through continuous monitoring of variables such as
cardiac output, mean arterial pressure, and venous oxygen saturation, it is possible to adapt therapeutic
interventions in real time, minimizing the risks of hemodynamic instability (SILVA et al., 2021).
During coronary artery bypass grafting, the use of advanced hemodynamic monitoring
allows early detection of circulatory changes that could go unnoticed with conventional methods.
The rapid identication of drops in cardiac output, for example, allows immediate correction with
adjustment of vasoactive drugs or uid replacement, preventing progression to multiple organ failure.
In addition, monitoring systemic vascular resistance helps in the accurate determination of the need for
vasopressors, preventing prolonged hypotension, which is associated with a worse prognosis in these
patients (OLIVEIRA et al., 2020).
The adequacy of uid therapy is another critical issue in the management of high-risk patients
undergoing CABG. In individuals with severe cardiac impairment, excessive uid administration can
lead to volumetric overload, contributing to pulmonary edema and congestive heart failure. On the
other hand, hypovolemia can also result in decreased cardiac output and inadequate tissue perfusion.
Advanced hemodynamic monitoring provides real-time data that allows you to accurately adjust the
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volume of uids administered, avoiding both overload and hypovolemia (PEREIRA, 2019).
Recent studies indicate that advanced hemodynamic monitoring also improves postoperative
outcomes in high-risk patients. By allowing faster and more precise interventions during the intraoperative
period, patients tend to have a more stable recovery, with a lower incidence of complications such as
cardiogenic shock, arrhythmias, and postoperative infection. Reduced length of stay in intensive care
units (ICU) and lower need for ventilatory support are additional benets observed in patients who have
undergone more accurate and continuous monitoring (ALVES et al., 2022).
However, the large-scale implementation of this technology still faces barriers. The high cost
of equipment and the need for specialized training for medical staff limit its availability in many health
centers, especially in developing countries. In addition, some studies point out that, despite the apparent
benets, advanced hemodynamic monitoring is not completely risk-free, as it can lead to incorrect
interpretations of data, depending on the professional’s experience, resulting in inadequate interventions
(COSTA et al., 2021).
Finally, the integration of advanced hemodynamic monitoring with other technologies, such
as intraoperative cardiac ultrasound and the use of biomarkers for the early detection of myocardial
lesions, offers an even more comprehensive view of the patient’s hemodynamic status. This multimodal
approach may become the norm in the near future, especially in high-risk surgeries, where each
additional parameter monitored contributes to greater treatment accuracy (MACHADO, 2020).
CONCLUSION
Advanced hemodynamic monitoring represents a crucial advance in the intraoperative
management of high-risk patients undergoing coronary artery bypass grafting. By offering accurate
real-time data on circulatory status, this technology allows for a more personalized and agile approach,
reducing the incidence of hemodynamic complications and improving clinical outcomes. Patients who
benet from this technology have a faster and more stable recovery, with lower rates of prolonged
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hospitalization and postoperative complications, such as cardiogenic shock and congestive heart failure.
In addition, advanced monitoring allows for more precise management of uid therapy,
avoiding both volumetric overload and hypovolemia, factors that could impair the prognosis of these
patients. The application of more targeted and immediate interventions ensures greater safety during
the procedure, especially in individuals with severe comorbidities.
However, the large-scale implementation of this technology still faces challenges, mainly
related to high costs and the need for specialized training. Therefore, although its benets are clear,
its application must be accompanied by policies that encourage the training of professionals and the
accessibility of health centers to this essential tool.
In conclusion, advanced hemodynamic monitoring has the potential to become a standard
practice in high-risk coronary artery bypass graft surgeries, especially when integrated with other
technologies and therapeutic approaches. Its effective use not only contributes to the safety and success
of the procedure, but also improves the quality of life of patients in the postoperative period, reducing
complications and recovery times.
REFERENCES
SOUZA, F. G., et al. Hemodynamic monitoring in cardiac surgeries: advances and challenges. Brazilian
Journal of Cardiology, 2020.
COSTA, R. A. Technologies in advanced monitoring: impact on high-risk cardiac surgeries. Cardiology
Today, 2021.
PEREIRA, L. B., et al. Continuous monitoring in cardiac surgeries: analysis of clinical outcomes and
therapeutic benets. Journal of Cardiovascular Surgery, 2022.
SANTOS, M. E., et al. Advances in the monitoring of high-risk surgical patients: future perspectives.
Journal of Medical Technology, 2021.
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SILVA, R. F., et al. Impact of hemodynamic monitoring in high-risk cardiac surgeries. Journal of
Cardiology, 2021.
OLIVEIRA, J. P., et al. Advanced hemodynamic therapy in coronary artery bypass graft surgery: a
systematic review. Brazilian Archives of Cardiology, 2020.
PEREIRA, M. A. Fluid management in cardiac surgeries: benets of advanced monitoring. Brazilian
Journal of Cardiac Surgery, 2019.
ALVES, C. T., et al. Advanced hemodynamic monitoring and postoperative outcomes in high-risk
patients. Brazilian Journal of Intensive Care, 2022.
COSTA, E. A., et al. Challenges of implementing advanced hemodynamic monitoring in health centers.
Journal of Health Technology, 2021.
MACHADO, A. F. Integration of technologies in intraoperative monitoring in cardiac surgeries. Journal
of Innovation in Health, 2020.
