Which cardiac surgical patients can benefit from placement of a pulmonary artery catheter?

The use of pulmonary artery catheters (PACs) during cardiac surgery varies considerably depending on local policy, ranging from use in 5–10% of the patient population to routine application. However, as in other clinical fields, recent years have witnessed a progressive decline in PAC use. One of the reasons for this is probably the increasing use of transoesophageal echocardiograpy, even though careful analysis of the information provided by PAC and transoesophageal echocardiograpy indicates that the two tools should be considered subsidiary rather than alternatives. The principal categories of cardiac patients who can benefit from PAC monitoring are those with present and those with possible haemodynamic instability. On this basis we can identify five groups: patients with impaired left ventricular systolic function; those with impaired right ventricular systolic function; those with left ventricular diastolic dysfunction; those with an acute ventricular septal defect; and those with a left ventricular assist device. This review highlights the specific role of PAC-derived haemodynamic data for each category.