Hemodynamics optimization during off-pump coronary artery bypass: the 'no compression' technique.
OBJECTIVE
Heart manipulation during OPCAB may cause hemodynamical instability in particular for access to the posterior and lateral walls. The 'no compression' technique involves enucleation of the heart without any compression on the cavities, and stabilization of the target area with a suction device. The impact of this technique on hemodynamics is assessed.


METHODS
In order to analyze a homogeneous group, 26 consecutive patients with triple grafts, one to each side of the heart in the same sequential order (posterior, lateral and anterior wall successively) were selected. Heart rate (HR), mean pulmonary arterial pressure (PAP, mmHg), pulmonary capillary wedge pressure (PCWP, mmHg), mean arterial pressure (MAP, mmHg), cardiac output index (COI, l/min per m(2)), and central venous saturation (SvO(2),%) were monitored. A coronary shunt was used for all the anastomoses.


RESULTS
HR was stable with baseline value of 60+/-10 and the highest value for the anterior wall, 63.6+/-8 (P=0.23). PAP and PCWP exhibited their highest increase, when compared with baseline, for the lateral wall, 23.9+/-4.7 vs. 20.7+/-6.2 (P=0.06), and 17.2+/-4.7 vs. 14.9+/-5.6 (P=0.16), respectively. MAP, COI and SvO(2), exhibited their largest drop, when compared with baseline, for the lateral wall too, 73.1+/-9.1 vs. 77.1+/-7.5 (P=0.12), 1.99+/-0.47 vs. 2.26+/-0.55 (P=0.09), and 70.5+/-8.4 vs. 74.8+/-9.3 (P=0.12), respectively.


CONCLUSIONS
None of the hemodynamical parameter differed significantly from baseline value for all three territories. While hemodynamics was perfectly maintained during the posterior and anterior walls revascularization, exposure of the lateral wall led to marginal changes only.
Mueller
Xavier M
XM
Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. xavier.mueller@chuv.hospvd.ch
Chassot
Pierre-Guy
PG
Zhou
Junging
J
Eisa
Karam M
KM
Chappuis
Carine
C
Tevaearai
Hendrik T
HT
von Segesser
Ludwig K
LK
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative