3 148

Cited 0 times in

Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors

 S. Y. OH  ;  J. K. SHIM  ;  Y. L. KWAK  ;  K. J. YOU  ;  J. C. KIM  ;  J. W. SONG 
 Acta Anaesthesiologica Scandinavica, Vol.55(7) : 870-877, 2011 
Journal Title
 Acta Anaesthesiologica Scandinavica 
Issue Date
BACKGROUND: Emergent conversion to an on-pump procedure during an off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients. METHODS: Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO(2) ) <60% during grafting. Pre-operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not. RESULTS: In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO(2) after sternum closure and a higher incidence of composite morbidity end points. CONCLUSION: COPD and pre-operative creatinine level were identified as independent risk factors of mechanical heart displacement-induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO(2) even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO(2) before or during grafting.
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Thoracic & Cardiovascular Surgery (흉부외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실)
Yonsei Authors
곽영란(Kwak, Young Lan) ; 김종찬(Kim, Jong Chan) ; 송종욱(Song, Jong Wook) ; 심재광(Shim, Jae Kwang) ; 오세영(Oh, Se Young) ; 유경종(Yoo, Kyung Jong)
사서에게 알리기
Full Text
RIS (EndNote)
XLS (Excel)


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.