Placing a saline bag underneath the displaced heart enhances transgastric transesophageal echocardiographic imaging during off-pump coronary artery bypass surgery.
ABSTRACT The authors hypothesized that placing a saline bag (saline-filled surgical glove) underneath a displaced heart would improve ultrasound transmission for transgastric (TG) imaging and transesophageal echocardiography (TEE) to visualize left ventricular regional wall motion (LV-RWM) during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery.
Prospective observational study.
Tertiary University Hospital.
Adult patients undergoing OPCAB surgery.
Intraoperative TEE examination MEASUREMENT AND MAIN RESULTS: For off-line analyses of LV-readable segments, mid-esophageal (ME, 4-chamber, 2-chamber, and long-axis) and TG (basal- and mid-short-axis) TEE views were recorded under 3 different intraoperative conditions in 13 cases of OPCAB surgery: Before cardiac displacement (Tcontrol), after cardiac displacement (Tdisplaced), and after placing the saline bag underneath the displaced heart (Tsaline-bag). There were more LV-readable segments in the 17-segment model using integrated ME and TG views(ME + TG views) at Tsaline-bag and Tcontrol (mean[95% confidence interval], 17[17-17] and 17[17-17]) than using ME+TG at Tdisplaced (15[15-16], P = 0.002 and P<0.001, respectively). Using ME + TG views provided more LV-readable segments in the 17-segment model than using ME views at Tsaline-bag (vs. 16[14-16], P < 0.001), but not at Tdisplaced (vs. 15[14-15]). Incidences of inadequate RWM monitoring (LV-readable segments<14/17 using ME + TG views) at Tsaline-bag and Tcontrol (all 0/13) were less frequent than at Tdisplaced (3/13, all P = 0.038). There were more LV-readable segments in TG basal- and mid-short-axis views at Tsaline-bag (median [range], 6[5-6] and 5[5-6]) than at Tdisplaced (0[0-2] and 0[0-1], all P < 0.05).
Placing a saline bag underneath the displaced heart enhances the ability of TEE to visualize global LV-RWM by improving TG TEE imaging during OPCAB surgery.
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ABSTRACT: In this prospective, observational study, we evaluated whether transesophageal echocardiography allows for monitoring left ventricular segmental wall motion during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery. On the basis of a pilot study that showed frequent loss of transgastric views during OPCAB surgery, we analyzed only midesophageal views. The midesophageal 4-chamber view, 2-chamber view, and long-axis view were recorded in 60 patients after opening the chest and placing an epicardial stabilizer on the displaced heart. Using the 16-segment model, 2 echocardiographers independently performed offline analysis of segmental wall motion. The percentage of patients in whom >or=14 left ventricular segments were readable was calculated at baseline and after cardiac displacement and placement of an epicardial stabilizer. At baseline, >or=14 segments were readable in 59 (98%) of 60 patients. After cardiac displacement, >or=14 segments were readable during 58 (76%) of 76 revascularizations of the left anterior descending coronary artery (P < 0.01 versus baseline), during 33 (83%) of 40 revascularizations of the left circumflex coronary artery (P < 0.01 versus baseline), and during 29 (94%) of 31 revascularizations of the right coronary artery (not significant). We conclude that the number of readable segments decreased after cardiac displacement but that availability of >or=14 readable segments allowed for reliable monitoring of segmental wall motion in 4 of 5 patients during OPCAB surgery.Anesthesia & Analgesia 11/2004; 99(4):965-73, table of contents. · 3.30 Impact Factor
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ABSTRACT: To evaluate and compare monitors of cardiac output during repositioning and stabilization of the heart for off-pump coronary artery bypass (OPCAB) surgery. Prospective, observational, clinical study. University teaching hospital. Consecutive patients scheduled to undergo elective OPCAB (n = 19). Monitoring, induction, and anesthesia followed a routine protocol for coronary artery bypass patients. This included the use of transesophageal echocardiography (TEE) and pulmonary artery catheter placement. After positioning and stabilization for OPCAB surgery, the changes in descending aortic flow velocity (VTI) times heart rate (HR) and the mixed venous oxygen saturation (SvO(2)) could be used to predict the changes in thermodilution cardiac output (TDCO) using the following model: deltaTDCO((calc))=-13.15+0.35(deltaVTI*HR)+0.61(deltaSvO(2)) where Delta indicates the percentage change from baseline values. The changes in mean arterial pressure, mean pulmonary artery pressure, and continuous cardiac output did not correlate with the changes in TDCO. The use of the VTI*HR, as determined by TEE, in addition to the SvO(2) can strengthen clinical decision making during repositioning and stabilization of the heart during OPCAB. Changes in the VTI*HR and SvO(2) can be used as surrogate markers for changes in CO during OPCAB surgery.Journal of Cardiothoracic and Vascular Anesthesia 03/2004; 18(1):43-6. · 1.45 Impact Factor
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ABSTRACT: The purpose of this study was to assess the patients' hemodynamics during off-pump coronary artery bypass graft (OPCABG) surgery. Continuous monitoring of the mean systemic arterial pressure (SAP), mean pulmonary arterial pressure (PAP), mixed venous oxygen saturation (SvO(2)) and cardiac output index (COI) was done on 55 patients undergoing complete OPCAB revascularization. Hemodynamic changes were recorded at the completion of the anastomosis before releasing coronary snaring and stabilization and compared to baseline. The mean age of the patients was 66.4+/-9.2 years, and on average 3.3+/-0.8 grafts per patient were performed. The average SAP drop after manipulations was -8.3+/-16.9 mmHg for the left anterior descending artery (LAD), -13.5+/-19.6 mmHg for the diagonal artery (DG), -14.6+/-13 mmHg for the optuse marginal artery (OM), and -14.2+/-13.5 mmHg for the right coronary artery. This was significant for all territories (P<0.01). The PAP significantly increased in all territories except OM (LAD: 3.7+/-6.3 mmHg, DG: 4.3+/-8.6 mmHg, OM: 1.1+/-7.2 mmHg, posterior descending artery: 2.7+/-5.6 mmHg; P<0.05). Variations in COI were significant in all territories (P<0.01) but more significantly in LAD and DG territories (-15+/-3% and -13+/-9%, respectively). The SvO(2) variations were <10% for all territories and reached only borderline significance (P=0.05) in all territories except OM. All these hemodynamic changes were well tolerated by all patients. Manipulation of the beating heart during OPCABG surgery brings significant fluctuations in the patients' hemodynamics. Mean PAP increase and COI drop were more significant during manipulation of the anterior territories suggesting a more severe diastolic restrictive disease during anterior wall manipulation.European Journal of Cardio-Thoracic Surgery 04/2002; 21(3):385-90. · 2.67 Impact Factor