Application of Non-Invasive Cardiac Output Monitoring in Enhanced Recovery After Surgery for Patients With Acute Type A Aortic Dissection
TL;DR
Integrating NICOM into the postoperative care of patients with ATAAD provides reliable, continuous hemodynamic data that facilitates precise, individualized management, and improves perioperative outcomes, underscoring the vital role of this method in implementing ERAS protocols in cardiac surgery.
Abstract
Background: To assess the clinical value of non-invasive cardiac output monitoring (NICOM) within an enhanced recovery after surgery (ERAS) protocol for patients undergoing acute type A aortic dissection (ATAAD) repair. Methods: This study included 242 patients who underwent total arch replacement for ATAAD between January 2024 and June 2025. Patients were stratified into two groups based on postoperative NICOM use (NICOM group, n = 141; control group, n = 101). This study compared hemodynamic parameters, 6-minute walk test (6MWT) results, postoperative recovery, and complications. Results: Baseline characteristics were similar between groups. While 30-day mortality and ventilator time were comparable, the NICOM group demonstrated significantly superior outcomes inintensive care unit (ICU) stays [3.0 (2.0–5.0) vs. 5.0 (3.0–8.0) days; p < 0.001] and hospitalization time [16.0 (11.0–21.0) vs. 19.0 (14.0–23.0) days; p = 0.001]. The NICOM group also showed lower unadjusted rates of reintubation (1.4% vs. 7.9%; p = 0.029), ICU readmission (2.1% vs. 8.9%; p = 0.036), shock (0.7% vs. 5.9%; p = 0.045), and acute heart failure (2.1% vs. 9.9%; p = 0.018), as well as a longer 6MWT distance at discharge [488.0 (433.0–532.0) vs. 457.0 (410.0–521.0) meters; p = 0.02]. However, after applying Bonferroni correction for multiple comparisons, only ICU stay and hospitalization time remained statistically significant; the differences in re‑intubation, ICU readmission, shock, acute heart failure, and 6MWT did not meet the corrected significance threshold. Conclusion: Integrating NICOM into the postoperative care of patients with ATAAD provides reliable, continuous hemodynamic data that facilitate precise, individualized management. This approach stabilizes circulation, reduces key complications, accelerates recovery, and improves perioperative outcomes, underscoring the vital role of this method in implementing ERAS protocols in cardiac surgery.