Pro: Continuous Cardiac Output and SvO2 Monitoring Should Be Routine During Off-Pump Coronary Artery Bypass Graft Surgery

Abstract

OFF-PUMP CORONARY ARTERY bypass surgery (OPCAB) has gained popularity in recent years as a technique of surgical myocardial revascularization. In the United States, about 20% to 25% of coronary artery bypass graft (CABG) surgeries are performed off-pump. 1 Parolari A. Pesce L.L. Trezzi M. et al. Performance of EuroSCORE in CABG and off-pump coronary artery bypass grafting: Single institution experience and meta-analysis. Eur Heart J. 2009; 30: 297-304 Crossref PubMed Scopus (60) Google Scholar The clinical advantages of OPCAB are the avoidance of the cross-clamping of the aorta and the reduced systemic inflammatory effects of cardiopulmonary bypass (CPB), which have been shown to reduce postoperative morbidity in low-risk and high-risk patients as well as in comparison with patients who underwent percutaneous coronary intervention. 2 Demaria R.G. Carrier M. Fortier S. et al. Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation. 2002; 106: I5-I10 PubMed Google Scholar , 3 Cheng D.C. Bainbridge D. Martin J.E. et al. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005; 102: 188-203 Crossref PubMed Scopus (385) Google Scholar , 4 Bainbridge D. Cheng D. Martin J. et al. Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention? A meta-analysis of randomized trials. Thorac Cardiovasc Surg. 2007; 133: 623-631 Abstract Full Text Full Text PDF Scopus (34) Google Scholar Nevertheless, abrupt manipulations of the heart during OPCAB surgery presents unique challenges to the cardiac anesthesiologist. 5 Grow M.P. Singh A. Fleming N.W. et al. Cardiac output monitoring during off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2004; 18: 43-46 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar