title: Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors.
abstract: BACKGROUND
  Emergent conversion to an on-pump procedure during an off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.
  
  
  METHODS
  Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO(2) ) <60% during grafting. Pre-operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.
  
  
  RESULTS
  In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO(2) after sternum closure and a higher incidence of composite morbidity end points.
  
  
  CONCLUSIONS
  COPD and pre-operative creatinine level were identified as independent risk factors of mechanical heart displacement-induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO(2) even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO(2) before or during grafting.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: S Y
authors.initials: SY
authors.lastname: Oh
authors.forename: J K
authors.initials: JK
authors.lastname: Shim
authors.forename: J W
authors.initials: JW
authors.lastname: Song
authors.forename: J C
authors.initials: JC
authors.lastname: Kim
authors.forename: K J
authors.initials: KJ
authors.lastname: You
authors.forename: Y L
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000009:adverse effects; D023381:Endpoint Determination; D005260:Female; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D003404:Creatinine; D010100:Oxygen