Document Detail

The severity of positional mitral regurgitation during off-pump coronary artery bypass grafting.
MedLine Citation:
PMID:  18583284     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The aims of this study were to elucidate the incidence of mitral regurgitation during off-pump coronary artery bypass (OPCAB) surgery to evaluate the relationship of the changes with ventricular function and possible mitral valve regurgitation caused by positioning. METHODS: Included in the study were 60 consecutive patients who underwent CAB grafting on the beating heart. We monitored several hemodynamic variables (systolic arterial pressure, mean arterial pressure, right atrial pressure, pulmonary capillary wedge pressure, and heart rate) at baseline and after each anastomosis and used transesophageal echocardiography (TEE) routinely after sternotomy, during each anastomosis, and after completion of the operation. Valvular functions, ejection fraction, and wall motion systolic index were recorded during each TEE evaluation. RESULTS: All of the patients underwent complete revascularization. We performed 132 consecutive OPCAB anastomoses in 60 patients (60 left anterior descending artery [LAD], 20 right coronary artery [RCA], 45 left circumflex coronary artery [LCX], and 7 diagonal artery grafts). During LCX anastomosis, 38 (84.4%) of 45 patients developed moderate mitral regurgitation. The wall motion score index (WMSI) significantly increased during CX grafting, as was demonstrated by higher WMSI values than for the RCA, diagonal, and LAD grafts. The ejection fraction was decreased significantly during CX and RCA anastomoses compared with baseline levels. The hemodynamic changes were in accord with these findings. The greatest hemodynamic compromise was seen during CX anastomosis. CONCLUSION: Positional mitral regurgitation occurs frequently and is a major contributor to hemodynamic instability during posterior- and lateral-wall revascularization during the OPCAB procedure.
Batuhan Ozay; Murat Sargin; Gunseli Abay; Bulend Ketenci; Sinan Kut; Yavuz Enc; Gokcen Orhan; Onder Teskin; Murat Demirtas
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  11     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2008  
Date Detail:
Created Date:  2008-06-27     Completed Date:  2009-04-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E145-51     Citation Subset:  IM    
Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
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MeSH Terms
Coronary Artery Bypass, Off-Pump / statistics & numerical data*
Mitral Valve Insufficiency / diagnosis*,  epidemiology*
Postoperative Complications / classification,  diagnosis*,  epidemiology*
Risk Assessment / methods*
Risk Factors
Treatment Outcome
Turkey / epidemiology

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

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