title: Hemodynamic changes during myocardial revascularization without extracorporeal circulation.
abstract: OBJECTIVE
  Cardiac positioning and stabilization during myocardial revascularization without extracorporeal circulation (ECC) may cause hemodynamic changes dependent to the surgical site. The objective of this study was to evaluate these changes during distal coronary anastomosis.
  
  
  METHODS
  Twenty adult patients undergoing myocardial revascularization without ECC were monitored by pulmonary artery catheter and transesophageal Echo Doppler. Hemodynamic data were collected at the following times before removing the stabilizer wall: (1) after volume adjustments, (2) at the beginning of distal anastomosis, and (3) after 5 minutes. Treated coronary arteries were grouped according to their location in the lateral, anterior, or posterior wall. Two-way ANOVA with repetition and Newman-Keuls post-test were used in the analysis. A p value < 0.05 was considered statically significant.
  
  
  RESULTS
  During myocardial revascularization without ECC, pulmonary artery wedge pressure showed elevation from 17.7 ± 6.1 to 19.2 ± 6.5 (p < 0.001) and 19.4 ± 5.9 mmHg (p < 0.001), while the central venous pressure went from 13.9 ± 5.4 to 14.9 ± 5.9 mmHg (p = 0.007) and 15.1 ± 6.0 mmHg (p = 0.006). Intermittent cardiac output was reduced from 4.70 ± 1.43 to 4.23 ± 1.22 (p < 0.001) and 4.26 ± 1.25 L.min(-1) (p < 0.001). According to transesophageal Doppler, a significant group-time interaction was observed in cardiac output, which was reduced in the lateral group from 4.08 ± 1.99 to 2.84 ± 1.82 (p = 0.02) and 2.86 ± 1.73 L.min(-1) (p = 0.02), and aortic blood flow, which went from 2.85 ± 1.39 to 1.99 ± 1.26 (p = 0.02) and 2.00 ± 1.21 L.min(-1) (p = 0.02). Other hemodynamic changes were not observed during anastomoses.
  
  
  CONCLUSIONS
  A significant hemodynamic deterioration was observed during myocardial revascularization without ECC. Transesophageal Doppler detected a decrease in cardiac output only in the lateral group.
authors: Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Brazil. silviakim@hotmail.com
authors: Silvia Minhye
authors: SM
authors: Kim
authors: Luiz Marcelo Sá
authors: LM
authors: Malbouisson
authors: José Otávio Costa
authors: JO
authors: Auler
authors: Maria José Carvalho
authors: MJ
authors: Carmona
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D014656:Vascular Surgical Procedures / Q000379:methods