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Evaluation of serial haemodynamic changes during coronary artery anastomoses in patients undergoing off-pump coronary artery bypass graft surgery: Initial experiences using two deep pericardial stay sutures and octopus tissue stabilizer

Authors
 Helen Ki Shinn  ;  Young Jun Oh  ;  Young Lan Kwak  ;  Choon Soo Lee  ;  Jong Hwa Lee  ;  Seung Ho Kim 
Citation
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol.25(6) : 978-984, 2004 
Journal Title
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 
ISSN
 1010-7940 
Issue Date
2004
MeSH
Aged ; Analysis of Variance ; Cardiac Output ; Cardiopulmonary Bypass ; Coronary Artery Bypass/methods* ; Female ; Hemodynamics* ; Humans ; Intraoperative Period ; Male ; Middle Aged ; Monitoring, Intraoperative/methods ; Oxygen/blood ; Prospective Studies ; Suture Techniques*
Keywords
Continuous cardiac output monitoring ; Mixed venous oxygen saturation ; Off-pump coronary artery bypass graft surgery
Abstract
OBJECTIVE: This study was designed to evaluate the serial haemodynamic changes during coronary artery anastomoses using two deep pericardial stay sutures and octopus tissue stabilizer in patients undergoing initial experiences of off-pump coronary artery bypass graft surgery (OPCAB) using continuous cardiac output and mixed venous oxygen saturation (SvO(2)) monitoring. METHODS: With IRB approval, thirty patients undergoing OPCAB were studied. Pulmonary artery catheter (PAC) for continuous cardiac output and SvO(2) monitoring was inserted before anaesthesia. Haemodynamic measurements were recorded after pericardiotomy for baseline value. During each coronary artery anastomosis, haemodynamic variables were measured at 1,3,5,10, and 15 min after the application of tissue stabilizer and after the removal. Vasopressors were used to maintain mean arterial pressure (MAP) higher than 60 mmHg. RESULTS: MAP and heart rate (HR) were maintained without significant change during the anastomoses of all three arteries. Cardiac index (CI), and SvO(2) decreased significantly after stabilizer application in all three arteries. CI was below 2.5 l/min/m(2) and SvO(2) was under 70% during left circumflex artery (LCX) anastomosis. The decrease in CI and SvO(2) were significantly greater during LCX anastomosis. The increase in mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) was significant only in left anterior descending artery (LAD). Central venous pressure (CVP) increased significantly during the anastomosis of all three coronary arteries. The differences in MPAP, PCWP and CVP among the three coronary arteries were not statistically significant. The highest dose of vasoconstrictor was used during LCX anastomosis. CONCLUSIONS: When the coronary anastomoses were performed with two deep pericardial stay sutures and octopus tissue stabilizer on the beating heart, CI and SvO(2) decreased significantly during all coronary artery anastomoses immediately after the stabilizer application and the degree of reduction in CI and SvO(2) increased with time, though MAP was maintained constantly. CI and SvO(2) during LCX anastomosis were consistently below normal values. Therefore close monitoring and proper managements are needed during graft anastomoses.
Full Text
http://ejcts.oxfordjournals.org/content/25/6/978.long
DOI
10.1016/j.ejcts.2004.02.031
Appears in Collections:
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
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Lee, Jong Wha(이종화)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/111176
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