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Abstract
Background: There is still controversy regarding the benefits of off-pump CABG and the stress that these procedures impose on the cardiac surgeon has not been previously studied. We sought to investigate whether off-pump operations are more demanding for the cardiac surgeon compared to the on-pump by evaluating the stress level by the cardiac variability indices. Methods: The heart rate variability indices, including the low frequency (LF), high frequency (HF), and low frequency/high frequency ratio (LF/HF), as well as heart rate (HR) were recorded throughout 17 on-pump and 16 offpump coronary artery bypass grafting (CABG) operations for an experienced cardiac surgeon. The operations were divided into six phases to indicate the most important surgical moments, which were subsequently compared between the two types of procedures. Results: There was a statistically significant difference (P-value<0.0001) in the surgical phases in terms of the LF, HF, LF/HF ratio, and HR. The HF, LF/HF and HR were also statistically significantly different with respect to the two types of surgeries (P-value < 0.01). The LF, however, did not show a statistically significant difference (P-value = 0. 485). The LF/HF in the off-pump CABGs showed a significant increase during posterior distal anastomosis and it thereafter declined gradually to its base level by the time of proximal anastomosis. The LF/HF in the on-pump CABGs showed an increase at the time of cannulation and cardiopulmonary bypass and it decreased afterwards to its base level by the time of posterior distal anastomosis and remained almost constant until the end of the operation. Conclusion: Our results indicated that the stress level of the surgeon is higher when performing off-pump operations compared to on-pump procedures; this was manifested by the difference in the heart rate variability indices.
Highlights
The off-pump cardiac surgeries can be beneficial to the patent by causing less mortality, stroke and atrial fibrillation, compared to on-pump; [1,2] the mental strain imposed on the cardiac surgeon during off-pump operations in contrast to on-pump ones has not been previously investigated and recent studies have cast doubt on its effectiveness in graft patency [3]
Our results indicated that the stress level of the surgeon is higher when performing off-pump operations compared to on-pump procedures; this was manifested by the difference in the heart rate variability indices
The high frequency (HF) spectral component is the result of the parasympathetic system and the low frequency (LF)/HF is controlled by the sympathetic system, but there is controversy over the LF inasmuch as some regard sympathetic modulation and others consider the effect of both sympathetic and parasympathetic nervous systems as being responsible for its generation. [4,5] Amongst these indices, the low frequency/ high frequency ratio (LF/HF) ratio has been proposed as a non-invasive quantitative measure of the autonomic nervous system activity [6] and is a favoured measurement of stress level
Summary
The off-pump cardiac surgeries can be beneficial to the patent by causing less mortality, stroke and atrial fibrillation, compared to on-pump; [1,2] the mental strain imposed on the cardiac surgeon during off-pump operations in contrast to on-pump ones has not been previously investigated and recent studies have cast doubt on its effectiveness in graft patency [3]. One of the more favourable methods in evaluating mental stress is the heart variability, which is a balance between the sympathetic and parasympathetic nervous systems. We sought to investigate whether off-pump operations are more demanding for the cardiac surgeon compared to the on-pump by evaluating the stress level by the cardiac variability indices
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