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Published on: September 9, 2020
Hemodynamic changes during posterior vessel off-pump coronary artery bypass: comparison between deep pericardial
Woo-Ik Chang1, Ki-Bong Kim, Jin Hee Kim
1Department of Thoracic and Cardiovascular Surgery, Seoul, South Korea.
Insights
Heart displacement during off-pump coronary artery bypass can alter hemodynamics. A vacuum-assisted apical suction device resulted in smaller hemodynamic changes compared to a deep pericardial suture technique for obtuse marginal branch grafting.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Hemodynamics
Background:
- Off-pump coronary artery bypass (OPCAB) surgery requires heart displacement to access posterior vessels.
- This displacement can lead to significant hemodynamic instability.
- Understanding these hemodynamic changes is crucial for patient safety during OPCAB.
Purpose of the Study:
- To investigate the hemodynamic alterations during OPCAB surgery specifically for the obtuse marginal (OM) branch.
- To compare the hemodynamic effects of two heart displacement methods: deep pericardial suture technique versus a vacuum-assisted apical suction device.
Main Methods:
- A prospective randomized study involving 20 patients undergoing OPCAB for OM grafting.
- Patients were assigned to either a deep pericardial suture technique (Group 1) or a vacuum-assisted apical suction device (Group 2).
- Key hemodynamic variables were monitored at baseline and at multiple time points during heart displacement and grafting.
Main Results:
- Both methods caused significant decreases in stroke volume index (SVI) and increases in central venous pressure during heart displacement.
- The vacuum-assisted device group showed significantly smaller percent changes in cardiac index, SVI, and right ventricular stroke work index compared to the suture technique group.
- These differences were most pronounced during OM grafting.
Conclusions:
- Both deep pericardial sutures and vacuum-assisted suction cause hemodynamic derangement, notably a decrease in SVI.
- The vacuum-assisted apical suction device appears to induce less severe hemodynamic changes during OM grafting in OPCAB surgery compared to the deep pericardial suture technique.
Background:
Displacement of the heart to expose posterior vessels during off-pump coronary artery bypass may cause hemodynamic derangement. The aims of this study were (1) to elucidate the hemodynamic changes during off-pump coronary artery bypass for the obtuse marginal branch (OM) of the left circumflex artery; and (2) to compare the hemodynamic changes caused by a deep pericardial suture technique with those caused by a vacuum-assisted apical suction device for displacement of the heart.
Methods:
Hemodynamic changes during posterior vessel off-pump coronary artery bypass were studied in a prospective randomized manner. A deep pericardial suture technique (group 1, n = 10) or a vacuum-assisted apical suction device (group 2, n = 10) was used to facilitate the exposure of the OM. Hemodynamic variables such as cardiac index, stroke volume index (SVI), mean arterial pressure, mean pulmonary artery pressure, central venous pressure, pulmonary capillary wedge pressure, heart rate, systemic vascular resistance, pulmonary vascular resistance, left ventricular stroke work index, and right ventricular stroke work index were monitored during off-pump coronary artery bypass. Hemodynamic data were obtained before revascularization of the left anterior descending coronary artery at a baseline (T0), 3 minutes after heart displacement for revascularization of OM (T1), 3 minutes after the beginning of OM grafting (T2), and 3 minutes after the completion of OM grafting and heart repositioning (T3).
Results:
There were no significant differences in the baseline hemodynamic variables (T0) between the two groups. In group 1, SVI, cardiac index, left ventricular stroke work index, and right ventricular stroke work index decreased significantly, and central venous pressure and pulmonary capillary wedge pressure increased significantly, during displacement of the heart (T1, p < 0.05). In group 2, SVI decreased significantly, and central venous pressure, pulmonary capillary wedge pressure, and mean pulmonary artery pressure increased significantly during displacement of the heart (T1, p < 0.05). The percent changes of cardiac index, SVI, and right ventricular stroke work index during OM grafting (T2) in comparison with baseline values (T0) were significantly larger in group 1 than in group 2 (cardiac index, 73% +/- 12% versus 90% +/- 11%; SVI, 69% +/- 12% versus 86% +/- 8%; right ventricular stroke work index, 30% +/- 17% versus 71% +/- 25%, in groups 1 versus 2, respectively; p < 0.05).
Conclusions:
Displacement of the heart using either a deep pericardial suture technique or a vacuum-assisted apical suction device caused a significant decrease in SVI. The hemodynamic changes during OM grafting were smaller when using a vacuum-assisted apical suction device.
