title: Monitoring diastolic dysfunction using a simplified algorithm in patients undergoing off-pump coronary artery bypass grafting surgery.
abstract: BACKGROUND
  Left ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off-pump coronary artery bypass grafting (OPCABG) surgery.
  
  
  OBJECTIVE
  The aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al. in patients undergoing OPCABG.
  
  
  METHODS
  The study was conducted in a tertiary care level hospital; this was a prospective, observational study.
  
  
  METHODS
  Fifty consecutive patients undergoing OPCABG were enrolled. Hemodynamic and echocardiographic parameters were measured at 6 stages in every patient namely after anesthetic induction (baseline), during left internal mammary artery (LIMA) to left anterior descending (LAD) grafting (LIMA → LAD), saphenous vein graft (SVG) to obtuse marginal (OM) grafting (SVG → OM), SVG to posterior descending artery (PDA) grafting (SVG → PDA), during proximal anastomosis of SVG to aorta, and postprotamine. The patients were classified in grades of LVDD as per simplified algorithm proposed by Swaminathan et al. using only intraoperatively measured E and E'.
  
  
  RESULTS
  The success rate of measurement and classification of LVDD was 98.92% (277 out of 280 measurements). The grades of LVDD varied significantly as per surgical steps with maximum downgrading occurring during OM and LAD grafting. During OM grafting, none of the patients had normal diastolic function while 29% of patients exhibited restrictive pattern (Grade 3 LVDD). Patients with normal baseline LV diastolic function also exhibited downgrading during OM and LAD grafting. Postprotamine, 37% of patients with normal baseline diastolic function continued to exhibit some degree of DD.
  
  
  CONCLUSIONS
  The LVDD changes dynamically during various stages of OPCABG, which can be successfully monitored with simplified algorithm.
authors.affiliation: Department of Cardiac Anesthesia, Ozone Anesthesia Group, United CIIGMA Hospital, Aurangabad, Maharashtra, India.
authors.forename: Deepak Prakash
authors.initials: DP
authors.lastname: Borde
authors.forename: Balaji
authors.initials: B
authors.lastname: Asegaonkar
authors.forename: Pramod
authors.initials: P
authors.lastname: Apsingekar
authors.forename: Sujeet
authors.initials: S
authors.lastname: Khade
authors.forename: Savni
authors.initials: S
authors.lastname: Futane
authors.forename: Bapu
authors.initials: B
authors.lastname: Khodve
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kedar
authors.forename: Anand
authors.initials: A
authors.lastname: Deodhar
authors.forename: Unmesh
authors.initials: U
authors.lastname: Takalkar
authors.forename: Antony
authors.initials: A
authors.lastname: George
authors.forename: Shreedhar
authors.initials: S
authors.lastname: Joshi
mesh_terms: D000368:Aged; D000465:Algorithms; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging