Korean J Anesthesiol.  2003 May;44(5):646-653. 10.4097/kjae.2003.44.5.646.

The Changes of Right Ventricular Function and Hemodynamic Parameters During Coronary Anastomosis in Beating Heart Surgery

• Jung SM
• Kwak YL
• Oh YJ
• Park JT
• Park JM
• Hong YW

• KMID: 1759983
• DOI: http://doi.org/10.4097/kjae.2003.44.5.646

Abstract

BACKGROUND: Hemodynamic derangement during the displacement of the beating heart in off-pump coronary artery bypass graft surgery (OPCAB) might be related with right ventricular (RV) dysfunction. This study evaluated the influence of displacing and stabilizing the heart, for the anastomosis of coronary arteries, on hemodynamic alterations and RV function in patients undergoing OPCAB.
METHODS
Twenty patients with triple vessel coronary artery disease underwent OPCAB using single pericardial sutures: a tissue stabilizer was included. The hemodynamic variables and right ventricular ejection fraction (RVEF) were obtained using a right-heart ejection fraction thermodilution pulmonary artery catheter after the induction of anesthesia, before and after anastomosis of each coronary artery and after sternal closure.
RESULTS
No significant hemodynamic changes were observed during the displacement of the heart or the placement of a stabilizer on all of the coronary arteries, except the obtuse marginal artery (OM) before anastomosis. RVEF, left ventricular stroke work index (LVSWI), stroke volume index and cardiac index (CI) decreased and mean pulmonary artery pressure increased significantly whist positioning the graft to the OM. Right ventricular volumes were not significantly changed, although central venous pressure and pulmonary capillary wedge pressure increased. Changing CI had a close relationship with LVSWI (r2 = 0.537, P <0.05) but not with RVEF (r2 = 0.118). These hemodynamic compromises recovered to baseline values after sternal closure.
CONCLUSIONS
The displacement of the beating heart for positioning during anastomosis of the graft to the OM caused significant hemodynamic instability and LV functional changes in addition to RV functional changes seemed to be responsible for hemodynamic derangements.

Keyword

Off-pump coronary artery bypass graft surgery; Right heart ejection fraction themodilution pulmonary artery catheter; Right heart function

MeSH Terms

Anesthesia
Arteries
Catheters
Central Venous Pressure
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Coronary Vessels
Heart*
Hemodynamics*
Humans
Pulmonary Artery
Pulmonary Wedge Pressure
Stroke
Stroke Volume
Sutures
Thermodilution
Thoracic Surgery*
Transplants
Ventricular Function, Right*