Document Detail


Evaluation of serial haemodynamic changes during coronary artery anastomoses in patients undergoing off-pump coronary artery bypass graft surgery: initial experiences using two deep pericardial stay sutures and octopus tissue stabilizer.
MedLine Citation:
PMID:  15144998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was designed to evaluate the serial haemodynamic changes during coronary artery anastomoses using two deep pericardial stay sutures and octopus tissue stabilizer in patients undergoing initial experiences of off-pump coronary artery bypass graft surgery (OPCAB) using continuous cardiac output and mixed venous oxygen saturation (SvO(2)) monitoring. METHODS: With IRB approval, thirty patients undergoing OPCAB were studied. Pulmonary artery catheter (PAC) for continuous cardiac output and SvO(2) monitoring was inserted before anaesthesia. Haemodynamic measurements were recorded after pericardiotomy for baseline value. During each coronary artery anastomosis, haemodynamic variables were measured at 1,3,5,10, and 15 min after the application of tissue stabilizer and after the removal. Vasopressors were used to maintain mean arterial pressure (MAP) higher than 60 mmHg. RESULTS: MAP and heart rate (HR) were maintained without significant change during the anastomoses of all three arteries. Cardiac index (CI), and SvO(2) decreased significantly after stabilizer application in all three arteries. CI was below 2.5 l/min/m(2) and SvO(2) was under 70% during left circumflex artery (LCX) anastomosis. The decrease in CI and SvO(2) were significantly greater during LCX anastomosis. The increase in mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) was significant only in left anterior descending artery (LAD). Central venous pressure (CVP) increased significantly during the anastomosis of all three coronary arteries. The differences in MPAP, PCWP and CVP among the three coronary arteries were not statistically significant. The highest dose of vasoconstrictor was used during LCX anastomosis. CONCLUSIONS: When the coronary anastomoses were performed with two deep pericardial stay sutures and octopus tissue stabilizer on the beating heart, CI and SvO(2) decreased significantly during all coronary artery anastomoses immediately after the stabilizer application and the degree of reduction in CI and SvO(2) increased with time, though MAP was maintained constantly. CI and SvO(2) during LCX anastomosis were consistently below normal values. Therefore close monitoring and proper managements are needed during graft anastomoses.
Authors:
Helen Ki Shinn; Young Jun Oh; Seung Ho Kim; Jong Hwa Lee; Choon Soo Lee; Young Lan Kwak
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  25     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-17     Completed Date:  2004-10-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  978-84     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Pain Medicine, Inha University College of Medicine, Inchon, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Aged
Analysis of Variance
Cardiac Output
Cardiopulmonary Bypass
Coronary Artery Bypass / methods*
Female
Hemodynamics*
Humans
Intraoperative Period
Male
Middle Aged
Monitoring, Intraoperative / methods
Oxygen / blood
Prospective Studies
Suture Techniques*
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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