Efficacy of early goal-directed therapy for hemodynamics stability in off-pump coronary artery bypass surgery

Off-pump coronary artery bypass surgery causes hemodynamic changes due to position and surgical manipulation, which directly affect cardiovascular function and increase the rate of postoperative complications. The study's goal was to evaluate the efficacy of early goal-directed therapy for hemodynamic stability in off-pump coronary artery bypass surgery. A case-control study was conducted between May 2022 and December 2024 in the Department of Anesthesiology and Critical Care at Military Hospital 175. Patients were monitored intraoperatively with ten time points using either the FloTrac/EV1000 system or conventional methods. Hemodynamic stability was measured by hemodynamic parameters (directly) and post-operative lactate levels (indirectly). The study included 70 patients (EGDT group: 36, Control group: 34). Baseline characteristics were similar between groups. Open surgery was performed in 90% of cases. Patients undergoing analysis recorded intraoperative hemodynamics with insignificant fluctuations of less than 5% in both groups. Both groups experienced a MAP nadir at T4 - post-anchoring suture (Control: 59.56 vs. EGDT: 62.42 mmHg). The EGDT group maintained significantly higher MAP After these points, the EGDT group showed faster MAP recovery. The EGDT implementation was associated with a 70% reduction in postoperative hyperlactatemia risk (OR 0.29; 95% CI 0.08-0.97; p = 0.023). Application of early goal-directed therapy in off-pump coronary artery bypass surgery showed hemodynamic stability, better control, and a statistical significance reduction in the risk of postoperative hyperlactatemia by 70%.