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Eur J Cardiothorac Surg 2002;21:385-390
© 2002 Elsevier Science NL

Hemodynamic changes during off-pump CABG surgery

^a Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
^b Department of Anesthesia, Montreal Heart Institute, Montreal, Quebec, Canada

Received 26 September 2001; received in revised form 6 December 2001; accepted 21 December 2001.

* Corresponding author. Research Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec, H1T 1C8, Canada. Tel.: +1-514-376-3330, ext. 3715; fax: +1-514-376-4766
e-mail: rc2910{at}aol.com

Objectives: The purpose of this study was to assess the patients' hemodynamics during off-pump coronary artery bypass graft (OPCABG) surgery. Methods: Continuous monitoring of the mean systemic arterial pressure (SAP), mean pulmonary arterial pressure (PAP), mixed venous oxygen saturation (SvO₂) and cardiac output index (COI) was done on 55 patients undergoing complete OPCAB revascularization. Hemodynamic changes were recorded at the completion of the anastomosis before releasing coronary snaring and stabilization and compared to baseline. Results: The mean age of the patients was 66.4±9.2 years, and on average 3.3±0.8 grafts per patient were performed. The average SAP drop after manipulations was -8.3±16.9 mmHg for the left anterior descending artery (LAD), -13.5±19.6 mmHg for the diagonal artery (DG), -14.6±13 mmHg for the optuse marginal artery (OM), and -14.2±13.5 mmHg for the right coronary artery. This was significant for all territories (P<0.01). The PAP significantly increased in all territories except OM (LAD: 3.7±6.3 mmHg, DG: 4.3±8.6 mmHg, OM: 1.1±7.2 mmHg, posterior descending artery: 2.7±5.6 mmHg; P<0.05). Variations in COI were significant in all territories (P<0.01) but more significantly in LAD and DG territories (-15±3% and -13±9%, respectively). The SvO₂ variations were <10% for all territories and reached only borderline significance (P=0.05) in all territories except OM. All these hemodynamic changes were well tolerated by all patients. Conclusions: Manipulation of the beating heart during OPCABG surgery brings significant fluctuations in the patients' hemodynamics. Mean PAP increase and COI drop were more significant during manipulation of the anterior territories suggesting a more severe diastolic restrictive disease during anterior wall manipulation.

Key Words: Off-pump coronary artery bypass surgery • Hemodynamics • Stabilizer • Ischemia

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