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Hemodynamics optimization during off-pump coronary artery bypass: the ‘no compression' technique

Mueller, Xavier M. ; Chassot, Pierre-Guy ; Zhou, Junging ; Eisa, Karam M. ; Chappuis, Carine ; Tevaearai, Hendrik T. ; von Segesser, Ludwig K.

In: European Journal of Cardio-Thoracic Surgery, 2002, vol. 22, no. 2, p. 249-254

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    Titre
    • Hemodynamics optimization during off-pump coronary artery bypass: the ‘no compression' technique
    Auteur
    • Mueller, Xavier M.. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • Chassot, Pierre-Guy. Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • Zhou, Junging. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • Eisa, Karam M.. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • Chappuis, Carine. Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • Tevaearai, Hendrik T.. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    • von Segesser, Ludwig K.. Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2002, vol. 22, no. 2, p. 249-254. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:291626
    Summary
    Objective: Heart manipulation during OPCAB may cause hemodynamical instability in particular for access to the posterior and lateral walls. The ‘no compression' technique involves enucleation of the heart without any compression on the cavities, and stabilization of the target area with a suction device. The impact of this technique on hemodynamics is assessed. Methods: In order to analyze a homogeneous group, 26 consecutive patients with triple grafts, one to each side of the heart in the same sequential order (posterior, lateral and anterior wall successively) were selected. Heart rate (HR), mean pulmonary arterial pressure (PAP, mmHg), pulmonary capillary wedge pressure (PCWP, mmHg), mean arterial pressure (MAP, mmHg), cardiac output index (COI, l/min per m2), and central venous saturation (SvO2,%) were monitored. A coronary shunt was used for all the anastomoses. Results: HR was stable with baseline value of 60±10 and the highest value for the anterior wall, 63.6±8 (P=0.23). PAP and PCWP exhibited their highest increase, when compared with baseline, for the lateral wall, 23.9±4.7 vs. 20.7±6.2 (P=0.06), and 17.2±4.7 vs. 14.9±5.6 (P=0.16), respectively. MAP, COI and SvO2, exhibited their largest drop, when compared with baseline, for the lateral wall too, 73.1±9.1 vs. 77.1±7.5 (P=0.12), 1.99±0.47 vs. 2.26±0.55 (P=0.09), and 70.5±8.4 vs. 74.8±9.3 (P=0.12), respectively. Conclusions: None of the hemodynamical parameter differed significantly from baseline value for all three territories. While hemodynamics was perfectly maintained during the posterior and anterior walls revascularization, exposure of the lateral wall led to marginal changes only