[Cerebral oxygen desaturation monitoring during off-pump coronary artery bypass grafting]

The evaluation of cerebral perfusion during off-pump coronary bypass grafting (OPCAB) has not been clarified. The aim of this study was to investigate the predictive value of neurobiochemical markers of brain damage and cerebral perfusion with respect to the neuropsychological outcomes after OPCAB.

Ten patients (4 males and 6 females) underwent OPCAB. All patients were performed brain CT preoperatively and 7 days postoperatively. We excluded the patients with cerebralvascular disease from this study. A 5.5 Fr oximetric catheter was placed in the jugular bulb, and we measured continuously SjO2 and mean arterial blood pressure during OPCAB. Venous serum level of neuron specific enolase (NSE) was measured preoperatively and 24 hours after skin closure.

There was correlation between mean blood pressure and SjO2 during anastomoses. The mean blood pressure during anastomoses of left anterior descending coronary artery (LAD), circumflex coronary artery (Cx), right coronary artery (RCA) were 68.6 +/- 12.9 mmHg, 60.9 +/- 9.3 mmHg, 64.1 +/- 14.1 mmHg. The SjO2 during anastomoses of LAD, Cx, RCA were 57.3 +/- 10.9%, 48.6 +/- 9.8%, 57.7 +/- 18.2%. There is tendency that the SjO2 during anastomosis of Cx was lower than others. No patients died, and there was no permanent neurologic deficit. Postoperatively, 2 patients had abnormal high NSE level.

Intraoperative continuous cerebral oxygen desaturation monitoring seems to be useful monitor for neuropsychological outcomes after OPCAB.