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Related Experiment Videos

Improving hemodynamics by atrial pacing during off-pump bypass surgery.

Vassilios Gulielmos1, Utz Kappert, Markus Eller

  • 1Department of Thoracic and Cardiovascular Surgery, Heart Center Dresden, University Hospital, Dresden, Germany. Vassilios.Gulielmos.hkz_dd@t-online.de

The Heart Surgery Forum
|January 15, 2004
PubMed
Summary

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Atrial pacing stabilizes hemodynamics during off-pump surgery by increasing blood pressure and cardiac output while decreasing stroke volume and left atrial pressure. This simple maneuver improves patient outcomes and reduces the need for cardiopulmonary bypass.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Off-pump coronary artery bypass grafting (OPCAB) presents challenges in maintaining hemodynamic stability.
  • Tilting the heart during OPCAB can lead to significant hemodynamic deterioration.
  • Atrial pacing is a potential strategy to mitigate these adverse effects.

Purpose of the Study:

  • To evaluate the hemodynamic effects of atrial pacing during off-pump surgery.
  • To assess the safety and efficacy of atrial pacing as a maneuver to stabilize hemodynamics.

Main Methods:

  • Eleven patients undergoing OPCAB were monitored using PiCCO catheters for cardiac output (CO), cardiac index (CI), stroke volume (SV), heart rate (HR), and systemic vascular resistance.
  • Mean and systolic arterial pressure (RRm, RRs) and left atrial pressure (LAP) were also monitored.

Related Experiment Videos

  • Hemodynamic parameters were recorded before and after the implementation of temporary atrial pacing.

    • Main Results:

    • Atrial pacing resulted in a statistically significant increase in RRs, RRm, HR, CO, and CI (P <.005).
    • A significant decrease was observed in SV (P <.005) and LAP (P < .05).
    • All patients survived without requiring inotropic support, and only 1 conversion to cardiopulmonary bypass occurred in 400 procedures.

    Conclusions:

    • Atrial pacing is an effective method for stabilizing hemodynamics during off-pump surgery.
    • The maneuver significantly improves key hemodynamic parameters, enhancing patient safety.
    • This technique contributes to a low rate of conversion to cardiopulmonary bypass in OPCAB procedures.