Impact of FloTrac/EV1000-guided intraoperative hemodynamic optimization on postoperative outcomes in cardiac valve surgery: a randomized controlled trial

Background Cardiac valve surgery is associated with significant postoperative morbidity and mortality. This study evaluated the impact of intraoperative hemodynamic optimization using FloTrac/EV1000 on postoperative outcomes in patients undergoing cardiac valve surgery. Methods In this single-center, prospective, randomized controlled trial, 82 patients undergoing elective cardiac valve surgery were randomly allocated to either FloTrac/EV1000 management (EV1000 group, n = 42) or conventional management (Control group, n = 40). The primary outcomes were ICU length of stay, duration of mechanical ventilation, and hospital length of stay. Secondary outcomes included vasoactive drug requirements, fluid balance, and postoperative complications. Results The EV1000 group had significantly shorter ICU stay (44.6 ± 6.3 vs. 63.9 ± 39.9 hours, p = 0.002) and hospital stay (11.4 ± 2.9 vs 13.2 ± 4.0 days, p = 0.021) compared to the Control group. The EV1000 group required more vasoactive drugs during pre-bypass (p = 0.018) but fewer before ICU transfer (p = 0.003) and during their ICU stay (p < 0.05). The incidence of postoperative ventricular fibrillation (0% vs 15.0%, p = 0.011), bradycardia (11.9% vs. 35.0%, p = 0.016), atrial fibrillation with rapid ventricular response (14.3% vs. 25.0%, p = 0.032), acute respiratory distress syndrome (0% vs. 5.0%, p = 0.045), and acute kidney injury (0% vs. 5.0%, p = 0.045) was lower in the EV1000 group. Conclusions FloTrac/EV1000-guided hemodynamic optimization in cardiac valve surgery resulted in shorter ICU and hospital stays, reduced postoperative vasoactive drug requirements, and fewer postoperative complications compared to conventional management. Trial registration NCT04292951 (The full date of first registration on ClinicalTrials.gov: March 1, 2020)