Changes in systolic and diastolic function during multivessel off-pump coronary bypass grafting

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Echocardiography

Background:

• Off-pump coronary artery bypass grafting (OPCAB) aims to reduce myocardial injury.
• Understanding ventricular function changes during OPCAB is crucial for patient outcomes.

Purpose of the Study:

• To quantify systolic and diastolic left ventricular (LV) function changes during OPCAB.
• To assess the impact of heart positioning and coronary flow interruption on LV function.

Main Methods:

• Utilized 2-D transesophageal echocardiography for systolic wall motion and diastolic function (E/A ratio, PVS/PVD ratio, deceleration time).
• Employed pulmonary artery catheter thermodilution for hemodynamic LV function measures.
• Collected data pre-operatively, intra-operatively, and post-operatively.

Main Results:

• Significant diastolic and systolic function changes occurred during left circumflex (LCX) grafting compared to right coronary artery (RCA) and left anterior descending artery (LAD) grafting.
• LCX grafting showed increased wall motion score index and E/A ratio, and decreased PVS/PVD ratio.
• All measured functional parameters reverted to baseline levels by the conclusion of the surgery.

Conclusions:

• Multivessel OPCAB is feasible with transient, mild LV dysfunction.
• Diastolic dysfunction is most pronounced during LCX grafting, indicating a restrictive filling pattern.
• Diastolic function monitoring can inform improved surgical strategies for LCX graft site access.