TEB vs. Swan-Ganz catheter: hemodynamic monitoring agreement in off-pump coronary artery bypass grafting.

摘要

OBJECTIVE: To compare the agreement of hemodynamic parameters measured by Swan-Ganz catheter and thoracic electrical bioimpedance (TEB) in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG), and to evaluate the clinical application value of TEB in perioperative hemodynamic monitoring. METHODS: A total of 42 CHD patients who underwent off-pump coronary artery bypass grafting (OPCABG) in the Department of Cardiac Surgery, Binzhou Medical University Hospital, from August 2021 to March 2022 were enrolled in this prospective observational study. All patients received continuous hemodynamic monitoring using both TEB and Swan-Ganz catheter throughout the surgical procedure, with simultaneous data collection. Cardiac output (CO), Stroke volume (SV), stroke volume index (SI), and end-diastolic volume (EDV) were recorded at two key time points (before thoracotomy and after chest closure) for statistical analysis. RESULTS: Bland-Altman corrected for repeated measurements revealed mean bias of -0.30 L/min (CO), -9.10 mL (SV), -5.10 mL/m2 (SI), and 69.80 mL (EDV); corresponding 95% limits of agreement (LOA) were -2.50 to 1.80 L/min, -47.70 to 29.60 mL, -27.10 to 16.80 mL/m2, and -55.45 to 195.10 mL respectively. The 95% LOA of all four indices fell within predefined clinical acceptable thresholds, whereas paired t-test demonstrated statistically significant inter-method differences for all measured parameters. CONCLUSION: TEB serves as a reliable, non-invasive tool for real-time continuous trend monitoring of CO, SV, SI, and EDV in critically ill surgical patients, especially those for whom invasive monitoring is contraindicated. This study supports the clinical application of TEB as an alternative or supplementary method for perioperative hemodynamic assessment in OPCABG patients.