Coronary artery bypass grafting on the beating heart without the use of cardiopulmonary bypass (CPB) has been expanded in cardiac surgery as a result of awareness of the damaging effect of CPB and improvements in surgical equipment and techniques. However, serious hemodynamic changes and subsequent myocardial ischemia and decrease in left ventricular performance can be still induced in the process of displacing the beating heart and restricting the cardiac motion to expose the planned anastomosis site during off-pump coronary bypass grafting (OPCAB) thus to complete revascularisation of the heart, a main challenge during the operation is to maintain haemodynamic stability during this procedure. The purpose of this study was to assess the patients’ hemodynamics during off-pump coronary artery bypass graft surgery.
Continuous monitoring of the mean arterial blood pressure (MAP), mean pulmonary arterial pressure (MPAP), heart rate (HR), mixed venous oxygen saturation (SvO2) and central venous pressure (CVP) was done on 30 patients undergoing complete OPCAB revascularization. Hemodynamic changes were recorded at the completion of the anastomosis before releasing coronary snaring and stabilization and compared to baseline.
Heart displacement induced a significant drop in mean arterial blood pressure and mixed venous oxygen saturation, but increase of the mean pulmonary artery pressure, heart rate and central venous pressure. HR was significantly increased in all arteries during anastmosis except ramus (RI) and highly significant at obtuse marginal (OM) and right coronary artery (RCA). CVP significantly increased in all arteries during anastmosis and highly significant at posterior descending artery (PDA) and RI. Mean PAP significantly increased in all arteries during anastmosis and highly significant at PDA and diagonal artery (DG). SvO2 significantly decreased in all arteries during anastmosis and highly significant at PDA and RCA. MAP significantly decreased in all arteries during anastmosis and highly significant at PDA, RI and RCA.
Conclusion: When the coronary anastomosis were performed with one deep pericardial stay sutures and octopus tissue stabilizer on the beating heart, mean ABP and SvO2 decreased significantly during all coronary artery anastomosis but pulmonary artery pressure, heart rate and central venous pressure was significantly increased in all arteries during anastmosis. Therefore ,close monitoring and proper managements are needed during graft anastomosis.
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