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Related Experiment Videos

Hemodynamics in off-pump surgery: normal versus compromised preoperative left ventricular function.

Giuseppe Fiore1, Maria Elena Latrofa, Pasquale Tunzi

  • 1Department of Emergency and Transplantation, University of Bari, U.O. Anestesia e Rianimazione I, U.O. Cardiochirurgia, A.O. Policlinico, Giuseppe Fiore, via A. De Ferraris 16, I-70124 Bari, Italy. pinofiore2003@libero.it

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 3, 2005
PubMed
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Off-pump coronary artery bypass grafting (OPCABG) is well-tolerated by patients with poor cardiac function. However, hemodynamic changes during OPCABG differ significantly between patients with poor versus good baseline cardiac performance.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Hemodynamics

Background:

  • Off-pump coronary artery bypass grafting (OPCABG) avoids cardiopulmonary bypass and cardioplegic arrest, potentially benefiting patients with compromised cardiac function.
  • Heart displacement during OPCABG poses a risk of cardiocirculatory collapse in high-risk patients.
  • Understanding the hemodynamic derangements during OPCABG in patients with poor cardiac function is crucial.

Purpose of the Study:

  • To investigate the hemodynamic changes induced by heart displacement during OPCABG in patients with varying baseline cardiac function.
  • To compare the hemodynamic responses between patients with poor (EF ≤ 30%) and good (EF > 30%) ejection fraction.

Main Methods:

  • Twenty-eight elective OPCABG patients were studied using arterial thermodilution to measure cardiac output and global end-diastolic volume.

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  • Hemodynamic parameters were recorded at baseline, during vessel exposure/stabilization, and post-surgery.
  • Patients were stratified into two groups based on baseline ejection fraction (EF): Group A (EF>30%) and Group B (EF≤30%).

    • Main Results:

    • Heart displacement caused significant reductions in cardiac and stroke index, with a less pronounced drop in mean arterial pressure due to increased systemic vascular resistance.
    • Global end-diastolic volume (preload) decreased significantly in Group A but remained stable or increased in Group B.
    • A significant linear relationship between preload index and left ventricular stroke work was observed only in Group A.

    Conclusions:

    • Patients with poor baseline cardiac function tolerate OPCABG effectively.
    • The pathophysiological mechanisms underlying hemodynamic changes during OPCABG differ between patients with poor and good preoperative cardiac function.
    • These findings highlight distinct hemodynamic adaptations in patients with compromised cardiac function undergoing OPCABG.