Ventricular Fibrillation during Off-Pump Coronary Artery Bypass Grafting: Transcranial Doppler and Clinical Findings

Abstract

A 73-year-old male developed ventricular fibrillation which lasted for 2 min and 24 s, during off-pump coronary artery bypass grafting. Cerebral hemodynamics were assessed by continuous transcranial Doppler monitoring. Ventricular fibrillation resulted in an immediate fall in cerebral blood flow velocities to almost zero with only slight fluctuations. This was then followed by a pronounced reactive hyperperfusion. Cerebral magnetic resonance imaging examinations and detailed neurological and neuropsychological evaluations were performed before and at 3 and 12 months after surgery. No evidence of cerebral damage was found.

Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery

“…We did not find similar results in the group without cardiopulmonary bypass, in which manipulation of the heart during off-pump surgery has the potential to cause episodes of hemodynamic instability and critical cerebral hypoperfusion without hypothermic protection. 25 Previous randomized trials of on-pump versus off-pump bypass surgery have failed to demonstrate significant independent effects of cardiopulmonary bypass on patientreported health status. [26][27][28] In the present study no independent statistical effect was observed of new postoperative lesions on self-reported health.…”

Methods of detecting potential causes of vascular cognitive impairment after coronary artery bypass grafting

“…However, during boffpumpQ surgery, there is more manipulation of the heart which may precipitate serious cardiac arrhythmias, with a subsequent fall in cerebral perfusion pressure. TCD monitoring will then immediately detect a significant fall in MCA blood flow velocities, which will enable the surgical team to take immediate corrective measures [15] (Fig. 4).…”