Evaluate the predictive accuracy of cvp/lap ratio for weaning from cpb in cabg surgery
DOI:
https://doi.org/10.61581/MJSP.VOL06/01/14Keywords:
Accuracy, CVP/LAP, CPB, CABG surgery, WeaningAbstract
Objective: This study aimed to evaluate the predictive accuracy of the CVP/LAP ratio for successful weaning from CPB in patients undergoing CABG surgery.
Methods: A prospective observational study was conducted involving 40 patients undergoing elective CABG surgery at the Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC) in Multan, Pakistan. Pre-pump and post-weaning CVP and LAP were measured, and the CVP/LAP ratio was calculated. Logistic regression analysis was used to assess the predictive value of the CVP/LAP ratio, and a receiver operating characteristic (ROC) curve was generated to evaluate its discriminative ability.
Results: The mean pre-pump CVP/LAP ratio was 0.83 (SD = 0.28). Logistic regression analysis showed that the CVP/LAP ratio had an overall predictive accuracy of 80% for successful weaning. However, the area under the ROC curve (AUC) was 0.68, indicating moderate discriminative power. The model failed to correctly classify unsuccessful weaning cases, highlighting limitations in using the CVP/LAP ratio as a standalone predictor.
Conclusions: The CVP/LAP ratio demonstrates moderate predictive accuracy for successful weaning from CPB in CABG surgery. However, its limitations suggest that it should be integrated into a broader clinical assessment rather than used in isolation. Further research is needed to develop more comprehensive predictive models.
Downloads
References
1. Mohr, F. W., et al. (2013). Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomized, clinical SYNTAX trial. The Lancet, 381(9867), 629-638.
2. Gravlee, G. P., et al. (2008). Cardiopulmonary Bypass: Principles and Practice. Lippincott Williams & Wilkins.
3. Tarhan, S., et al. (2010). Predictors of difficult separation from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting. Journal of Cardiothoracic and Vascular Anesthesia, 24(3), 500-505.
4. Magder, S. (2006). Central venous pressure: useful measurement or meaningless number? Critical Care Medicine, 34(8), 2224-2227.
5. Maharaj, R., & Ryder, M. (2017). The interpretation of central venous pressure measurements in a hemodynamically unstable patient. International Journal of Critical Illness and Injury Science, 7(2), 117-120.
6. Barrett, N. A., et al. (2014). The use of combined left atrial and central venous pressure monitoring to guide perioperative fluid therapy in cardiac surgery. European Journal of Anaesthesiology, 31(9), 518-524.
7. Sawyer, M., & Blumenthal, N. (2018). Hemodynamic monitoring in cardiac surgery: the role of pressure measurements. Current Anesthesiology Reports, 8(3), 254-262.
8. Johnson, D. J., et al. (2016). Predictive value of CVP/LAP ratio in determining outcomes post-cardiac surgery. Annals of Cardiac Anaesthesia, 19(4), 601-607.
9. McGee, W. T., & Davies, S. J. (2017). Monitoring central venous pressure: A systematic review. Critical Care and Resuscitation, 19(1), 43-49.
10. Marik, P. E., & Baram, M. (2012). Noninvasive hemodynamic monitoring in the intensive care unit. Current Opinion in Critical Care, 18(3), 293-298.
11. Reuter, D. A., et al. (2010). Fluid responsiveness in mechanically ventilated patients. Best Practice & Research Clinical Anaesthesiology, 24(2), 217-229.
12. Galvagno, S. M., et al. (2018). The role of central venous pressure as a predictor of cardiac function during weaning from cardiopulmonary bypass. Journal of Cardiothoracic Surgery, 13(1), 1-7.
13. Kumar, A., et al. (2015). Evaluation of CVP/LAP ratio as a predictor for successful weaning from cardiopulmonary bypass in CABG patients. Indian Journal of Thoracic and Cardiovascular Surgery, 31(2), 145-150.
14. Lee, S. H., & Park, K. H. (2017). Combined hemodynamic indices for predicting weaning success from cardiopulmonary bypass. Korean Journal of Anesthesiology, 70(3), 330-337.
15. Thompson, M. J., et al. (2019). Limitations of central venous to left atrial pressure ratio in predicting cardiac performance post-CPB. Journal of Cardiothoracic and Vascular Anesthesia, 33(5), 1234-1240.
16. Singh, A., et al. (2016). Impact of preoperative left ventricular dysfunction on weaning from cardiopulmonary bypass. Asian Cardiovascular and Thoracic Annals, 24(2), 112-118.
17. Ferreira, V. H., et al. (2014). Role of transesophageal echocardiography in perioperative hemodynamic monitoring. Brazilian Journal of Anesthesiology, 64(6), 377-387.
18. Lambert, J., et al. (2018). Advanced hemodynamic monitoring in cardiac surgery: an integrative approach. Journal of Cardiothoracic and Vascular Anesthesia, 32(6), 2809-2820.
19. Ahmed, A., et al. (2020). Integration of hemodynamic monitoring techniques for improved prediction of weaning outcomes from CPB. Perfusion, 35(4), 295-302.
20. Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143(1), 29-36.
21. Perrino, A. C., & Reeves, S. T. (2019). Perioperative hemodynamic monitoring in cardiac surgery: current trends and future directions. Journal of Cardiothoracic and Vascular Anesthesia, 33(6), 1640-1652.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Dr Zainab Fareed, Muhammad Azeem Mir , Kaneez ume Farwa , Muhammad Hamid Chaudhary

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.