Improving hemodynamics by atrial pacing during off-pump bypass surgery.
BACKGROUND
To avoid hemodynamic deterioration during tilting of the heart in off-pump surgery, we perform atrial pacing. We describe hemodynamic evaluation of this simple maneuver.


METHODS
Eleven consecutive patients (8 men, 3 women; age, 68.14 +/- 10.3 years; left ventricular ejection fraction, 51.17% +/- 18.6%) admitted for coronary artery bypass grafting were equipped with a PiCCO catheter (Pulsion Medical Systems, Munich, Germany) for monitoring of cardiac output (CO), cardiac index (CI), stroke volume (SV), heart rate (HR), and systemic vascular resistance. In addition, mean and systolic arterial pressure (RRm, RRs) as well as left atrial pressure (LAP) were monitored. During the procedure, temporary pacemaker wires were installed, and hemodynamic monitoring was performed before and after atrial pacing. All procedures were performed with the same standardized offpump technique.


RESULTS
All patients survived the procedure without inotropic support. In all cases a branch of the circumflex artery was grafted. The number of grafts per patient was 2.7. There was a statistically significant increase in RRs (11.12 mm Hg), RRm (9.72 mm Hg), HR (31.6 beats/min), CO (1.09 L/min), and CI (0.61 L/min per m2) (P <.005). SV decreased statistically significantly (11.8 mL, P <.005) as did LAP (6 mm Hg, P < .05).


CONCLUSIONS
Atrial pacing increases intraoperative RRs, RRm, CO, and CI and decreases SV and LAP significantly, thus offering stable hemodynamics during off-pump surgery. In the last 400 consecutive off-pump coronary artery bypass grafting procedures, there was only 1 (0.25%) conversion to cardiopulmonary bypass.
Gulielmos
Vassilios
V
Department of Thoracic and Cardiovascular Surgery, Heart Center Dresden, University Hospital, Dresden, Germany. Vassilios.Gulielmos.hkz_dd@t-online.de
Kappert
Utz
U
Eller
Markus
M
Sahre
Heiko
H
Alexiou
Konstantin
K
Georgi
Christian
C
Nicolai
Joachim
J
Hartmann
Nikolaus
N
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology