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Published on: September 15, 2023
Microcirculatory response during on-pump versus off-pump coronary artery bypass graft surgery
Marc Bienz1, David Drullinsky2, Louis-Mathieu Stevens3
1Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Insights
Off-pump coronary artery bypass graft surgery (CABG) showed transient microcirculatory benefits compared to on-pump CABG. However, these differences diminished postoperatively, suggesting temperature management may be key for preserving microcirculation.
Area of Science:
- Cardiovascular Surgery
- Microcirculation Research
- Surgical Outcomes
Background:
- Cardiopulmonary bypass (CPB) in coronary artery bypass graft surgery (CABG) triggers systemic inflammation and alters microcirculation.
- Understanding the impact of surgical techniques on microcirculatory function is crucial for patient outcomes.
Purpose of the Study:
- To investigate whether beating heart surgery (off-pump CABG, OPCABG) preserves sublingual microcirculation compared to conventional on-pump CABG (ONCABG).
Main Methods:
- Sublingual microcirculation was assessed using Sidestream Darkfield Imaging during OPCABG and ONCABG.
- Microcirculatory parameters were analyzed at eight perioperative time points.
Main Results:
- Microcirculation quality declined during early ONCABG.
- OPCABG demonstrated significantly better microcirculation for three parameters during surgery.
- No significant differences in microcirculatory parameters were observed between groups by the end of surgery or postoperatively.
Conclusions:
- OPCABG did not show marked microcirculatory preservation compared to ONCABG.
- Observed microcirculatory changes correlated with body temperature fluctuations.
- Active warming strategies may influence perioperative microcirculation parameters.
Objectives:
The use of cardiopulmonary bypass (CPB) during coronary artery bypass graft surgery (CABG) is associated with a systemic inflammatory response, resulting in altered microcirculation. The aim of this study was to evaluate whether beating heart surgery can preserve the microcirculation.
Methods:
Sublingual microcirculation was characterized by a Sidestream Darkfield Imaging Microscope during off-pump (OPCABG) and on-pump (ONCABG) surgery. Microcirculatory parameters were evaluated during eight precise perioperative time points.
Results:
The quality of the microcirculation decreased during early ONCABG. OPCABG resulted in a significantly better microcirculation compared to ONCABG for three of six parameters during surgery. However, by the end of surgery and postoperatively, the microcirculatory parameters were no different between the groups.
Conclusions:
While the results do not show a marked preservation of the microcirculation during and after OPCABG compared to ONCABG, they coincide with the body temperature fluctuations of each group during and after surgery. Our work suggests that active warming could impact the microcirculation parameters.
