158 Off Pump CABG Improves Intra-Operative Microcirculation: A Preliminary Report

Abstract

BackgroundCardiopulmonary bypass (CPB), with its non-pulsatile flow and related inflammatory response, has been associated with shut down of the sub-lingual microcirculation. Off pump coronary artery bypass grafting (CABG) has been proposed to avoid the complications related to the use of CPB. In the recent CORONARY trial and other studies, off pump CABG demonstrated a significant reduction in kidney and pulmonary failure, suggesting a better preservation in tissue perfusion. The aim of this study was to compare the sublingual microcirculation during elective on- and off-pump CABG.MethodsThe sublingual microcirculation in 10 patients undergoing elective cardiac surgery on normothermic cardiopulmonary bypass was compared to the microcirculation of 10 patients undergoing off pump CABG. For this, a side-stream dark-field imaging microscope was used. Measurements were obtained at the end of the last distal anastomosis. Only vessels below 25 μm in diameter were studied and flow was categorized using a semi-quantitative approach and classified into no flow, intermittent, slugish, contiuous and hyperdynamic. Several microcirculation parameters were compared between groups.ResultsBetween both groups there was a significative difference in microcirculation during the distal anastomosis time. This differences where seen on total small vessel length, proportion of perfused small vessels and the density of small vessels with continuous flow.ConclusionTabled 1 BackgroundCardiopulmonary bypass (CPB), with its non-pulsatile flow and related inflammatory response, has been associated with shut down of the sub-lingual microcirculation. Off pump coronary artery bypass grafting (CABG) has been proposed to avoid the complications related to the use of CPB. In the recent CORONARY trial and other studies, off pump CABG demonstrated a significant reduction in kidney and pulmonary failure, suggesting a better preservation in tissue perfusion. The aim of this study was to compare the sublingual microcirculation during elective on- and off-pump CABG. Cardiopulmonary bypass (CPB), with its non-pulsatile flow and related inflammatory response, has been associated with shut down of the sub-lingual microcirculation. Off pump coronary artery bypass grafting (CABG) has been proposed to avoid the complications related to the use of CPB. In the recent CORONARY trial and other studies, off pump CABG demonstrated a significant reduction in kidney and pulmonary failure, suggesting a better preservation in tissue perfusion. The aim of this study was to compare the sublingual microcirculation during elective on- and off-pump CABG. MethodsThe sublingual microcirculation in 10 patients undergoing elective cardiac surgery on normothermic cardiopulmonary bypass was compared to the microcirculation of 10 patients undergoing off pump CABG. For this, a side-stream dark-field imaging microscope was used. Measurements were obtained at the end of the last distal anastomosis. Only vessels below 25 μm in diameter were studied and flow was categorized using a semi-quantitative approach and classified into no flow, intermittent, slugish, contiuous and hyperdynamic. Several microcirculation parameters were compared between groups. The sublingual microcirculation in 10 patients undergoing elective cardiac surgery on normothermic cardiopulmonary bypass was compared to the microcirculation of 10 patients undergoing off pump CABG. For this, a side-stream dark-field imaging microscope was used. Measurements were obtained at the end of the last distal anastomosis. Only vessels below 25 μm in diameter were studied and flow was categorized using a semi-quantitative approach and classified into no flow, intermittent, slugish, contiuous and hyperdynamic. Several microcirculation parameters were compared between groups. ResultsBetween both groups there was a significative difference in microcirculation during the distal anastomosis time. This differences where seen on total small vessel length, proportion of perfused small vessels and the density of small vessels with continuous flow. Between both groups there was a significative difference in microcirculation during the distal anastomosis time. This differences where seen on total small vessel length, proportion of perfused small vessels and the density of small vessels with continuous flow. ConclusionTabled 1