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Relationship between echocardiographic index of ventricular filling pressure and intraoperative haemodynamic changes during off-pump coronary bypass surgery.

 J. K. Shim  ;  Y. S. Choi  ;  D. H. Chun  ;  S. W. Hong  ;  D. H. Kim  ;  Y. L. Kwak 
 BRITISH JOURNAL OF ANAESTHESIA, Vol.102(3) : 316-321, 2009 
Journal Title
Issue Date
Aged ; Blood Flow Velocity ; Coronary Artery Bypass, Off-Pump/methods* ; Echocardiography, Doppler/methods ; Female ; Hemodynamics* ; Humans ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve/physiopathology ; Monitoring, Intraoperative/methods ; Oxygen/blood ; Prognosis ; Prospective Studies ; Stroke Volume ; Ventricular Function, Left ; Ventricular Pressure
anaesthesia ; cardiovascular ; heart ; myocardial function ; measurement technique ; Doppler echocardiography ; surgery ; off-pump coronary artery bypass
BACKGROUND: The ratio of mitral velocity to early-diastolic velocity of the mitral annulus (E/e') is an indicator of diastolic function representing acute loading conditions of the left ventricle. We tested the efficacy of E/e' as a predictor of haemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB), when heart displacement causes loading changes. METHODS AND RESULTS: Fifty patients with left ventricular (LV) ejection fraction >or= 50% were divided into two groups; E/e'<8 (normal LV filling pressure, n=25) and >15 (increased LV filling pressure, n=25). Haemodynamic measurements were recorded after induction of anaesthesia, during grafting, and after sternum closure. Patients' characteristics and operative data were similar between the groups. Cardiac index and mixed venous oxygen saturation were significantly lower during grafting and after sternum closure in the E/e'>15 group, compared with E/e'<8 group and with the baseline values. The E/e'>15 group required significantly longer ventilation time and length of stay in the intensive care unit. CONCLUSIONS: Even in patients with preserved systolic LV function, patients with E/e'>15 were more prone to undergo a significant decrease in cardiac output during OPCAB, which did not return to baseline level after completion of grafting. Whether this finding is associated with increased morbidity and mortality should be validated.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Chun, Duk Hee(전덕희)
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
Hong, Seong Wook(홍성욱)
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