Con: Continuous Cardiac Output and SvO2 Monitoring Are Not Routine In Off-Pump Coronary Artery Bypass Grafting

Birmingham, Sean D.; Nguyen, Liem; Banks, Dalia A.

doi:10.1053/j.jvca.2012.03.013

Cited by 1 publication

(1 citation statement)

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“…These devices may provide valuable information from a trending viewpoint, which may be useful for hemodynamic management in intra- and postoperative period. Accurate and timely data regarding these endpoints may signify the difference between carry-on the case off-pump or urgently convert it to on-pump surgery [ 29 ] . In this case series, no premonitory changes that could trigger an alarm for shifting the operative strategy were detected and that might be related to the number of patients included, so further increasing the caseload may be of help in elucidating this question.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Changes During Heart Displacement in Aorta No-Touch Off-Pump Coronary Artery Bypass Surgery: A Pilot Study

Carvalho¹,

Guizilini²,

Murai³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveTo evaluate the sequential changes of hemodynamic and metabolic parameters in patients who underwent aorta no-touch off-pump coronary artery bypass surgery (OPCAB).MethodsProspective study involving twenty-seven consecutive patients who underwent aorta no-touch OPCAB. The FloTrac/PreSep/Vigileo™ system (Edwards Lifesciences) was used to continuously record heart rate (HR), mean arterial blood pressure (MABP), central venous pressure (CVP), continuous cardiac index (FCI), stroke volume (SV), stroke volume variation (SVV), and central venous oxygen saturation (ScvO2). The parameters were assessed 5 min before, during and 5 min after each anastomosis (left anterior descending [LAD], posterior descending [PD], obtuse marginal [OM] and diagonal [Dg]). Postoperative lactate was also evaluated.ResultsThere was no significant change in HR and MABP for all anastomoses, except for MABP during PD grafting (-10.1±2.7 mmHg, P=0.03). There was a significant decrease in ScvO2 only during PD and OM anastomoses (-9.4±0.4, P=0.03; -4.4±0.4, P=0.02; respectively). CVP drop after PD manipulation was strongly associated with a higher lactate during the first hours after surgery (r=-0.82; P=0.001). These hemodynamic changes were transient and entirely recovered after the heart was returned to its anatomical position. No significant differences were observed in FCI, SVV, or the systemic vascular resistance index (SVRI) during all anastomoses, except for a drop in SVRI during PD grafting (-8.03±2.3, P=0.007). SV tended to decrease during the procedure in all territories, but with statistically significant drop only in PD and OM grafting (-10.4±1.2, P=0.02; -13.6±5.1, P=0.007; respectively).ConclusionHeart displacement for performing aorta no-touch OPCAB is well tolerated, with transient and endurable hemodynamic variations.

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Section: Discussionmentioning

confidence: 99%