Analysis of thoracic aortic blood flow during off-pump coronary artery bypass surgery.
OBJECTIVE
The non-invasive monitoring of thoracic aortic blood flow (TABF) during off-pump coronary artery bypass (OPCAB) surgery is becoming more commonly used and proved to be invaluable in the early detection of haemodynamic compromise due to heart displacement. The aim of this study was to analyze the changes in the TABF during OPCAB using transoesophageal Doppler and compare them with the changes observed by other monitoring methods as cardiac output, invasive pulmonary and radial pressures and mixed venous oxygen saturation.


METHODS
The measurements obtained from classic haemodynamic monitoring methods including the radial artery line and the pulmonary artery catheter with continuous monitoring of the cardiac output and mixed venous blood oxygen saturation were compared to the measurements of TABF obtained from a transoesophageal Doppler probe in 15 consecutive patients who underwent OPCAB surgery.


RESULTS
The TABF decreased significantly during the construction of coronary anastomoses from 3.42 +/- 0.94 l/min (baseline) to 2.2 +/- 0.8 l/min during the first coronary anastomosis and then to 2.14 +/- 1.12 l/min during the second coronary anastomosis (F=4.29, P=0.008). TABF returned to the baseline values (2.85 +/- 1.19 l/min) at chest closure. The cardiac output measurement showed no significant decrease compared to baseline.


CONCLUSIONS
Low TABF occurred without significant changes in the measurements obtained from classic haemodynamic monitoring methods during OPCAB surgery. This finding could be of vital importance in helping improve the monitoring and consequently the management of patients undergoing OPCAB surgery.
Decoene
Christophe
C
Service d'anesthésie-réanimation cardiologique, Hopital cardiologique, CHRU de Lille, France.
Modine
Thomas
T
Al-Ruzzeh
Sharif
S
Athanasiou
Thanos
T
Fawzi
Dina
D
Azzaoui
Richard
R
Pol
Annie
A
Fayad
Georges
G
D000704:Analysis of Variance; D001013:Aorta, Thoracic / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood
D010100:Oxygen