Abstract
Background: The off-pump coronary artery bypass graft surgery (OPCAB) may produce significant hemodynamic instability necessitating conversion to on-pump surgery. This study evaluated the hemodynamic parameters in patients undergoing OPCAB using pericardial bands for stabilization of the coronary target sites. Methods: In 250 patients undergoing OPCAB the hemodynamic parameters including continuous cardiac output and systemic venous oxygen saturation (SvO2) were recorded at baseline after pericardiotomy, during each coronary artery anastomosis at 3, 5, 10, 15 min, and after release of the pericardial bands used for target stabilization. Vasopressors were used to maintain mean arterial pressure (MAP) > 60 mmHg. Results: SvO2 and cardiac index (CI) decreased significantly after target stabilization and during all coronary anastomoses with greater decreases noted during obtuse marginal branch of left circumflex (OM) anastomosis. The MAP and heart rate were maintained without significant change but central venous pressure increased significantly during all coronary anastomoses. The significant increase in pulmonary capillary wedge pressure and mean pulmonary artery pressure were noted only during anastomosis of the left anterior descending artery. The highest dose of vasopressor was used during OM anastomosis. Conclusions: During OPCAB surgery using pericardial bands for coronary target stabilization, MAP was maintained constantly, but SvO2 and CI decreased immediately after target stabilization and reduced further during all coronary artery anastomoses. During OM anastomosis SvO2 and CI were significantly lower as compared to that of LAD and right coronary artery. Careful monitoring and management of hemodynamic variables are warranted to avoid conversion to on-pump technique.
Highlights
The off-pump coronary artery bypass graft surgery (OPCAB) is being expanded in recent years because of the advantage of avoiding cardiopulmonary bypass (CPB) and its attendant complications, improvements in techniques as well as recent introduction of instruments to optimally stabilize the coronary targets on a beating heart. [1,2,3,4,5]
This study evaluated the use of pericardial bands for coronary target stabilization, noting serial hemodynamic parameters recorded during coronary artery anastomoses
During RCA anastomosis, the heart rate (HR) was significantly increased throughout the procedure (T3 to T15 and at sterna closure) compared to the baseline value, but mean arterial pressure (MAP) decreased only initially at T3
Summary
The off-pump coronary artery bypass graft surgery (OPCAB) is being expanded in recent years because of the advantage of avoiding cardiopulmonary bypass (CPB) and its attendant complications, improvements in techniques as well as recent introduction of instruments to optimally stabilize the coronary targets on a beating heart. [1,2,3,4,5]. The introduction of mechanical stabilizers such as CTS pressure mechanical stabilizers, epicardial fixation by suction devices and the Medtronic-Utrecht Octopus system, (Medtronic Inc, Minneapolis, MN), produced adequate cardiac immobilization of the coronary target site for performance of a safe anastomosis [6]. The hemodynamic instability that occurs during positioning of the heart and stabilization of the coronary targets with interruption of coronary blood flow are important factors limiting the safe performance of OPCAB. Several studies have been performed noting the changes in hemodynamic parameters and management of hemodynamic instability during OPCAB using mechanical stabilizers for coronary target stabilization and hemodynamic variables measured in most of these studies were either sparse or were measured only once during procedure without noting the progress of hemodynamic change dur-. This study evaluated the use of pericardial bands for coronary target stabilization, noting serial hemodynamic parameters recorded during coronary artery anastomoses
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