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Eur J Cardiothorac Surg 2001;20:913-917
© 2001 Elsevier Science NL
a Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
b Department of Anesthesia, Duke University Medical Center, Durham, NC 27710, USA
Received 7 October 2000; received in revised form 11 July 2001; accepted 18 July 2001.
Corresponding author. Box 3094, Duke University Medical Center, Durham, NC 27710, USA. Tel.: +1-919-681-2085; fax: +1-919-681-8994
e-mail: cleme004{at}mc.duke.edu
Objective: To measure the changes in systolic and diastolic left ventricular function that occur during off-pump coronary artery bypass grafting (OPCAB) as a consequence of positioning the heart and interrupting coronary flow. Methods: 2-D Transoesophageal echocardiography was used to derive systolic wall motion indices and pulsed Doppler parameters of diastolic function including the E/A ratio, PVS/PVD ratio, and deceleration time. A continuous cardiac output thermodilution pulmonary artery catheter was used to provide hemodynamic measures of left ventricular function. Data was obtained prior to, during and following coronary grafting. Results: Thirty-four consecutive anastomoses were evaluated, including eight circumflex (LCX), 17 left anterior descending artery (LAD) and nine right coronary artery (RCA) anastamoses. Significant changes in diastolic and systolic cardiac function were identified in those patients who underwent LCX grafting. Specifically during LCX grafting, both wall motion score index (2.4±1.4 vs 1.5±0.63 and 1.9±0.91) and the E/A ratio were significantly increased (3.5±1.4 vs 1.1±0.33 and 1.2±0.44) when compared to RCA and LAD grafting, respectively. The PVS/PVD ratio was significantly decreased during left circumflex grafting (0.7±0.45 vs 1.1±0.19 and 1.0±0.58) when compared to RCA and LAD grafting, respectively. All functional parameters returned to baseline by the end of surgery. Conclusions: Multivessel OPCAB can be achieved with mild impairment of left ventricular function that returns to baseline by the end of the procedure. Impairment of diastolic function is most marked during circumflex grafting as demonstrated by a restrictive filling pattern. Measures of diastolic function may be helpful in developing better strategies for exposure of the circumflex graft site.
Key Words: Off-pump coronary bypass grafting • Left ventricular function
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