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Eur J Cardiothorac Surg 2004;26:85-88
© 2004 Elsevier Science NL

Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion

Department of Cardiac Surgery, Cork University Hospital, Cork, Ireland

Received 23 December 2003; received in revised form 20 February 2004; accepted 10 March 2004.

^* Corresponding author. Tel.: +353-21-454-3000
e-mail: rgea{at}hotmail.com

Objective: Aim of this study was to investigate modifications of coronary grafts flow during different pacing modalities after CABG. Materials and methods: Two separate prospective studies were conducted in patients undergoing CABG and requiring intraoperative epicardial pacing. In a first study (22 patients) coronary grafts flows were measured during dual chamber pacing (DDD) and during ventricular pacing (VVI). In a second study (10 patients) flows were measured during DDD pacing at different atrio-ventricular (A-V) delay periods. A-V delay was adjusted in 25 ms increments from 25 to 250 ms and flow measurements were performed for each A-V delay increment. A transit time flowmeter was used for the measurements. Results: An average of 3.4 grafts/patient were performed. In the first study, average coronary graft flow was 47.4±20.8 ml/min during DDD pacing and 41.8±18.2 ml/min during VVI pacing (P=0.0004). Furthermore average systolic pressure was 94.3±10.1 mmHg during DDD pacing and 89.6±12.2 mmHg during VVV pacing (P=0.0007). No significant differences in diastolic pressure were recorded during the two different pacing modalities. In the second study, maximal flows were achieved during DDD pacing with an A-V delay of 175 ms (54±9.6 ml/min) and minimal flows were detected at 25 ms A-V delay (38.1±4.7 ml/min) (P=ns). No significant differences in systolic or diastolic blood pressure were noticed during the different A-V delays. Conclusion: Grafts flowmetry provides an extra tool to direct supportive measures such as cardiac pacing after CABG. DDD mode with A-V delay around 175 ms. should be preferred to allow for maximal myocardial perfusion via the grafts.

Key Words: Cardiac pacing • Coronary flow • Transit time flow measurement

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