Related Experiment Videos
A prospective randomized study to evaluate splanchnic hypoxia during beating-heart and conventional coronary
Theodore Velissaris1, Augustine Tang, Matthew Murray
1Department of Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. theo@velissaris.com
Summary
Cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) led to similar gut mucosal hypoxia in both on-pump and off-pump groups. Off-pump surgery showed worse trends postoperatively, despite better overall oxygen delivery.
Area of Science:
- Cardiovascular Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) is linked to gastrointestinal complications due to gut mucosal hypoxia.
- Understanding gastric mucosal oxygenation during coronary artery bypass grafting (CABG) is crucial for patient outcomes.
Purpose of the Study:
- To compare gastric mucosal oxygenation and whole-body oxygen flux in patients undergoing CABG with and without CPB.
- To investigate the impact of on-pump (ONCAB) versus off-pump (OPCAB) techniques on splanchnic oxygenation.
Main Methods:
- Randomized trial of 54 low-risk CABG patients into ONCAB (n=27) and OPCAB (n=27) groups.
- Continuous monitoring of gastric intramucosal pH (pHi) and CO(2) gap, alongside global oxygen delivery (DO(2)) and consumption (VO(2)).
- Measurements taken intraoperatively and up to 6 hours postoperatively.
Main Results:
- Both groups experienced similar intraoperative drops in pHi.
- ONCAB patients showed preserved pHi postoperatively, while OPCAB patients had further deterioration (P=0.03).
- OPCAB group demonstrated superior global oxygen delivery (DO(2)) and consumption (VO(2)).
Conclusions:
- Gastric mucosal hypoxia occurred similarly in both groups, with worsening trends in OPCAB patients postoperatively.
- Despite better global oxygen flux in OPCAB, splanchnic pathophysiology requires further investigation.
- The findings suggest that beating-heart surgery may not fully protect against gastric mucosal hypoxia.