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Superior mesenteric artery blood flow modifications during off-pump coronary surgery
Giuseppe Fiore1, Nicola Brienza, Pasquale Cicala
1Dipartimento dell'Emergenza e Trapianti d'Organo, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy. pinofiore@yahoo.it
The Annals of Thoracic Surgery
|June 27, 2006
Summary
Off-pump coronary surgery temporarily reduces gut blood flow due to heart displacement. Mesenteric blood flow recovers and increases post-surgery, indicating a hyperemic response. Transesophageal echo-Doppler monitors splanchnic perfusion during surgery.
Area of Science:
- Cardiovascular Surgery
- Gastrointestinal Physiology
- Hemodynamics
Background:
- Patients undergoing cardiac surgery face a high risk of gut hypoperfusion.
- Off-pump surgery may cause hemodynamic changes that reduce splanchnic perfusion.
- Assessing superior mesenteric artery blood flow during off-pump surgery is crucial.
Purpose of the Study:
- To prospectively evaluate blood flow modifications in the superior mesenteric artery during off-pump coronary artery bypass grafting.
- To investigate the impact of heart displacement on splanchnic perfusion.
- To utilize transesophageal echocardiography for intraoperative blood flow assessment.
Main Methods:
- 19 patients undergoing elective off-pump coronary revascularization were studied.
- Systemic hemodynamics and superior mesenteric artery blood flow were measured using transesophageal echo-Doppler.
- Measurements were taken at baseline, during anastomosis, during heart displacement, and at the end of surgery.
Main Results:
- Superior mesenteric blood flow significantly decreased during heart displacement (T2).
- Cardiac output also reduced during heart displacement.
- Mesenteric blood flow increased significantly by the end of surgery (T3), with a higher percentage of cardiac output directed to the mesenteric bed.
Conclusions:
- Off-pump coronary surgery-induced hemodynamic changes lead to significant mesenteric hypoperfusion.
- A subsequent hyperemic response in mesenteric blood flow is observed at the end of surgery.
- Transesophageal echo-Doppler is effective for intraoperative measurement of splanchnic visceral blood flow.
