Document Detail


Hemodynamic changes during posterior vessel off-pump coronary artery bypass: comparison between deep pericardial sutures and vacuum-assisted apical suction device.
MedLine Citation:
PMID:  15561035     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Displacement of the heart to expose posterior vessels during off-pump coronary artery bypass may cause hemodynamic derangement. The aims of this study were (1) to elucidate the hemodynamic changes during off-pump coronary artery bypass for the obtuse marginal branch (OM) of the left circumflex artery; and (2) to compare the hemodynamic changes caused by a deep pericardial suture technique with those caused by a vacuum-assisted apical suction device for displacement of the heart. METHODS: Hemodynamic changes during posterior vessel off-pump coronary artery bypass were studied in a prospective randomized manner. A deep pericardial suture technique (group 1, n = 10) or a vacuum-assisted apical suction device (group 2, n = 10) was used to facilitate the exposure of the OM. Hemodynamic variables such as cardiac index, stroke volume index (SVI), mean arterial pressure, mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure, heart rate, systemic vascular resistance, pulmonary vascular resistance, left ventricular stroke work index, and right ventricular stroke work index were monitored during off-pump coronary artery bypass. Hemodynamic data were obtained before revascularization of the left anterior descending coronary artery at a baseline (T0), 3 minutes after heart displacement for revascularization of OM (T1), 3 minutes after the beginning of OM grafting (T2), and 3 minutes after the completion of OM grafting and heart repositioning (T3). RESULTS: There were no significant differences in the baseline hemodynamic variables (T0) between the two groups. In group 1, SVI, cardiac index, left ventricular stroke work index, and right ventricular stroke work index decreased significantly, and central venous pressure and pulmonary capillary wedge pressure increased significantly, during displacement of the heart (T1, p < 0.05). In group 2, SVI decreased significantly, and central venous pressure, pulmonary capillary wedge pressure, and mean pulmonary artery pressure increased significantly during displacement of the heart (T1, p < 0.05). The percent changes of cardiac index, SVI, and right ventricular stroke work index during OM grafting (T2) in comparison with baseline values (T0) were significantly larger in group 1 than in group 2 (cardiac index, 73% +/- 12% versus 90% +/- 11%; SVI, 69% +/- 12% versus 86% +/- 8%; right ventricular stroke work index, 30% +/- 17% versus 71% +/- 25%, in groups 1 versus 2, respectively; p < 0.05). CONCLUSIONS: Displacement of the heart using either a deep pericardial suture technique or a vacuum-assisted apical suction device caused a significant decrease in SVI. The hemodynamic changes during OM grafting were smaller when using a vacuum-assisted apical suction device.
Authors:
Woo-Ik Chang; Ki-Bong Kim; Jin Hee Kim; Byung Moon Ham; Yong Lak Kim
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-11-24     Completed Date:  2005-07-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  2057-62     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure
Coronary Artery Bypass, Off-Pump*
Coronary Disease / physiopathology*,  surgery
Female
Hemodynamics*
Humans
Male
Middle Aged
Prospective Studies
Stroke Volume
Suction / instrumentation*
Suture Techniques*

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


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