Article

Hemodynamics in off-pump surgery: normal versus compromised preoperative left ventricular function.

Department of Emergency and Transplantation, University of Bari, U.O. Anestesia e Rianimazione I, U.O. Cardiochirurgia, A.O. Policlinico, Giuseppe Fiore, via A. De Ferraris 16, I-70124 Bari, Italy.
European Journal of Cardio-Thoracic Surgery (impact factor: 2.55). 03/2005; 27(3):488-93. DOI:10.1016/j.ejcts.2004.11.018 pp.488-93
Source: PubMed

ABSTRACT Off-pump coronary surgery (OPCABG), avoiding cardiopulmonary bypass and cardioplegic arrest, seems to be a better choice in patients with poor baseline cardiac function. Since cardiocirculatory collapse could be induced by heart displacement in this group of patients at high risk, a greater pathophysiologic understanding of the hemodynamic derangements occurring in such patients is needed.
Twenty-eight elective OPCABG patients were evaluated for hemodynamic changes induced by heart displacement, using arterial thermodilution to measure cardiac output and global end-diastolic volume. Hemodynamic parameters were recorded: at baseline; during proper exposure and stabilization of each vessel; and at the end of surgery. Patients were divided into two groups, according to baseline ejection fraction (EF): group A (EF>30%; N=16), group B (EF< or =30%; N=12).
Heart displacement induced a significant drop in the cardiac and stroke index, with a lesser decrease of mean arterial pressure because of raised systemic vascular resistance. Preload, measured as global end diastolic volume, significantly decreased in group A, while it remained unchanged or increased in group B. Linear regression between the preload index and left ventricular stroke work was significant only in group A.
Patients with poor baseline cardiac function can well tolerate OPCABG. However, the pathophysiologic modifications underlying the hemodynamic changes are different compared to those in patients with good preoperative cardiac performance.

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    Article: Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery.
    P S Halvorsen, A Espinoza, R Lundblad, M Cvancarova, P K Hol, E Fosse, T I Tønnessen
    [show abstract] [hide abstract]
    ABSTRACT: Haemodynamic instability during off-pump coronary artery bypass surgery (OPCAB) may appear rapidly, and continuous monitoring of the cardiac index (CI) during the procedure is advisable. With the PiCCO monitor, CI can be measured continuously and almost real time with pulse-contour analysis and intermittently with transthoracic thermodilution. The agreement between pulmonal artery thermodilution CI (Tpa), transthoracic thermodilution CI (Tpc) and pulse-contour CI (PCCI) during OPCAB surgery has not been evaluated sufficiently. In 30 patients scheduled for OPCAB surgery, a pulmonary artery catheter and a PiCCO catheter were inserted. At different time points during surgery, Tpa, Tpc and PCCI were compared. Measurements were performed after induction of anesthesia (T1), after pericardiothomy (T2), after grafting on the anterior (T3), posterior (T4) and lateral (T5) walls and after chest closure (T6). The PCCI was recalibrated at time point T2-T6. Mean difference and the limits of agreements (percentage error) between Tpa and Tpc were: -0.14 +/- 0.60 (22.0%) l/min/m2, between Tpa and PCCI: -0.07 +/- 0.92 (33.5%) l/min/m2 and between Tpc and PCCI: 0.10 +/- 1.00 (35.5%) l/min/m2. For changes in CI from one time point to the next (DeltaCI), the limits of agreements between DeltaCI Tpa and DeltaCI Tpc were 0.04 +/- 0.90 l/min/m2, between DeltaCI Tpa and DeltaCI PCCI: -0.02 +/- 1.22 l/min/m2 and between DeltaCI Tpc and DeltaCI PCCI: -0.08 +/- 1.32 l/min/m2. In OPCAB surgery, limits of agreement comparing thermodilution methods were smaller than comparing PCCI with thermodilution. Recalibration of PCCI is therefore advisable.
    Acta Anaesthesiologica Scandinavica 11/2006; 50(9):1050-7. · 2.19 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

baseline ejection fraction
 
cardiopulmonary bypass
 
elective OPCABG patients
 
global end diastolic volume
 
global end-diastolic volume
 
good preoperative cardiac performance
 
greater pathophysiologic understanding
 
group A
 
group B
 
group B. Linear regression
 
hemodynamic changes
 
hemodynamic changes induced
 
Hemodynamic parameters
 
lesser decrease
 
measure cardiac output
 
Off-pump coronary surgery
 
poor baseline cardiac function
 
significant drop
 
systemic vascular resistance
 
ventricular stroke work
 

Giuseppe Fiore