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Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time†
MedLine Citation:
PMID:  25392231     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia and is clinically difficult to diagnose. In a CABG model, we aimed at defining variables that detect hypoperfusion in real-time and correlate with impaired regional ventricular function by monitoring myocardial tissue metabolism.
METHODS: Off-pump CABG was performed in 10 pigs. Graft blood flow was reduced in 18 min intervals to 75, 50, and 25% of baseline flow with reperfusion between each flow reduction. Myocardial tissue Pco2 ([Formula: see text]), Po2, pH, glucose, lactate, and glycerol from the graft supplied region and a control region were obtained. Regional cardiac function was assessed as radial strain.
RESULTS: In comparison with baseline, myocardial pH decreased during 75, 50, and 25% flow reduction (-0.15; -0.22; -0.37, respectively, all P<0.05) whereas [Formula: see text] increased (+4.6 kPa; +7.8 kPa; +12.9 kPa, respectively, all P<0.05). pH and [Formula: see text] returned to baseline upon reperfusion. Lactate and glycerol increased flow-dependently, while glucose decreased. Regional ventricular contractile function declined significantly. All measured variables remained normal in the control region. [Formula: see text] correlated strongly with tissue lactate, pH, and contractile function (R=0.86, R=-0.91, R=-0.70, respectively, all P<0.001). New conductometric [Formula: see text] sensors were in agreement with established fibre-optic probes. Cardiac output was not altered.
CONCLUSIONS: Myocardial pH and [Formula: see text] monitoring can quantify the degree of regional tissue hypoperfusion in real-time and correlated well with cellular metabolism and contractile function, whereas cardiac output did not. New robust conductometric [Formula: see text] sensors have the potential to serve as a clinical cardiac monitoring tool during surgery and postoperatively.
Authors:
S E Pischke; S Hyler; C Tronstad; J Bergsland; E Fosse; P S Halvorsen; H Skulstad; T I Tønnessen
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-12
Journal Detail:
Title:  British journal of anaesthesia     Volume:  -     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-13     Completed Date:  -     Revised Date:  2014-11-14    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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