Characteristic changes in cerebral perfusion during on-pump and off-pump coronary artery surgery.
OBJECTIVE
We investigated the cerebral perfusion status during on-pump or off-pump coronary artery bypass grafting (CABG).


METHODS
We monitored somatosensory evoked potential (SEP) and regional cerebral oxygen saturation (rSO2) as parameters of cerebral perfusion in an on-pump group (n=10) and an off-pump group (n=16). The percent changes from control values were calculated before, during, and after aortic clamping, and after weaning from cardiopulmonary bypass, in the on-pump group. In the off-pump group, these were calculated before, during, and after heart displacement for distal anastomosis.


RESULTS
In the on-pump group, the amplitudes of the SEP were significantly enhanced during and after aortic cross-clamping and were associated with a significant decrease in rSO2. Latency was prolonged immediately after aortic cross-clamping, but was shortened afterwards. There was little change in these parameters throughout the operation, in the off-pump group.


CONCLUSIONS
Cerebral perfusion remains stable during off-pump CABG. The etiology of a simultaneous increase in SEP amplitude and decrease in rSO2 during the rewarming period in the on-pump group requires further investigation.
Ueno
Tetsuya
T
Division of Cardiovascular Surgery, Ureshino Medical Center, Ureshino-machi, Saga, Japan.
Ikeda
Kazuyuki
K
Matsuyama
Shigefumi
S
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome