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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Insights
Emergent conversion during off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is risky. Chronic obstructive pulmonary disease (COPD) and high creatinine are key predictors. Patients with these factors face worse outcomes.
Area of Science:
- Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Emergent conversion to on-pump procedures during off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability increases patient morbidity and mortality.
- Identifying predictors of hemodynamic instability during OPCAB is crucial for improving patient outcomes.
- Mechanical heart displacement during OPCAB can precipitate hemodynamic compromise.
Purpose of the Study:
- To evaluate predictors of hemodynamic instability during OPCAB.
- To assess the clinical outcomes of patients experiencing hemodynamic instability during OPCAB.
- To identify risk factors associated with mechanical heart displacement-induced hemodynamic instability.
Main Methods:
- Retrospective review of 494 patients undergoing elective, isolated OPCAB.
- Definition of hemodynamic instability as mixed venous oxygen saturation (SvO(2)) <60% during grafting.
- Logistic regression analysis to identify pre-operative predictors, including diastolic dysfunction and mitral regurgitation (MR).
Main Results:
- Univariate analysis identified body mass index, diabetes mellitus, COPD, reduced ejection fraction, diastolic dysfunction, MR, elevated creatinine, and diuretic use as risk factors.
- Multivariate analysis revealed COPD and pre-operative creatinine as independent predictors of hemodynamic instability.
- Patients with instability showed lower cardiac output and SvO(2) post-sternum closure, with higher composite morbidity.
Conclusions:
- Chronic obstructive pulmonary disease (COPD) and elevated pre-operative creatinine are independent risk factors for hemodynamic instability during OPCAB.
- Patients experiencing instability have persistently low SvO(2) and adverse outcomes.
- Preemptive strategies to augment SvO(2) may be beneficial for high-risk patients before or during grafting.
Background:
Emergent conversion to an on-pump procedure during an off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.
Methods:
Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO(2) ) <60% during grafting. Pre-operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.
Results:
In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO(2) after sternum closure and a higher incidence of composite morbidity end points.
Conclusion:
COPD and pre-operative creatinine level were identified as independent risk factors of mechanical heart displacement-induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO(2) even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO(2) before or during grafting.
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