title: Local cardiac wall stabilization influences the reproducibility of regional wall motion during off-pump coronary artery pass surgery.
abstract: OBJECTIVE
  Myocardial ischemia is a risk factor during off-pump coronary artery bypass procedures. The development of new regional wall motion abnormalities assessed by transesophageal echocardiography (TEE) is a very sensitive sign of myocardial ischemia. To facilitate anastomosis, the epicardial area of the anastomosis site is often immobilized by a "stabilizer." This study was designed to investigate whether cardiac wall stabilization with an epicardial stabilizer could affect the interpretation of wall motion during coronary anastomosis without cardiopulmonary bypass.
  
  
  METHODS
  The TEE videotapes of 15 adult patients were investigated. Left ventricular (LV) transgastric short and long axis views were divided according to a modified 16-segment method. LV wall motion was scored using a 5-grade scale by two independent blinded investigators during pre-occlusion, occlusion, and reperfusion of anastomosed coronary arteries. The wall motion scores of a stabilized segment combined with two adjacent segments were compared with those of non-stabilized segments. Interobserver agreement was assessed using the weighted kappa statistic.
  
  
  RESULTS
  A total of 216 segments were analyzed by two investigators. The interobserver kappa coefficient in pre-occlusion and reperfusion periods was 0.87, 0.87 and 0.86, 0.87, respectively, indicating high agreements without stabilizer. During the occlusion period in stabilized and non-stabilized segments, it was 0.59 and 0.76, respectively, showing significantly less reproducibility in the presence of stabilizer.
  
  
  CONCLUSIONS
  Cardiac wall stabilization affects the reproducibility in the interpretation of regional wall motion during off-pump coronary artery bypass surgery. Caution should be used when monitoring for myocardial ischemia using TEE during coronary artery bypass surgery with epicardial stabilizer.
authors.affiliation: Department of Anesthesiology, Nippon Medical School, Sendagi 1-1-5, Bunkyo-ku, Tokyo 113-8603, Japan. shiga/anesth@nms.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Shiga
authors.forename: K
authors.initials: K
authors.lastname: Terajima
authors.forename: J
authors.initials: J
authors.lastname: Matsumura
authors.forename: A
authors.initials: A
authors.lastname: Sakamoto
authors.forename: R
authors.initials: R
authors.lastname: Ogawa
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D015588:Observer Variation; D015203:Reproducibility of Results