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Eur J Cardiothorac Surg 2003;23:917-924
© 2003 Elsevier Science NL

A prospective randomized study to evaluate splanchnic hypoxia during beating-heart and conventional coronary revascularization

^a Department of Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
^b Department of Anaesthesia, Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK

Received 27 August 2002; received in revised form 17 January 2003; accepted 3 February 2003.

^* Corresponding author. Tel.: +44-23-8077-7222; fax: +44-23-8079-8508
e-mail: theo{at}velissaris.com

Objective: Cardiopulmonary bypass (CPB) is associated with gut mucosal hypoxia, which may contribute to gastrointestinal complications. We examined gastric mucosal oxygenation together with whole-body oxygen flux in low-risk patients undergoing coronary artery bypass grafting (CABG) with and without CPB. Methods: Fifty-four patients undergoing primary CABG by the same surgeon were randomized into either on-pump (ONCAB, n=27) or off-pump (OPCAB, n=27) groups. The ONCAB group underwent mild hypothermic (35°C) pulsatile CPB with arterial line filtration. Each patient underwent perioperative monitoring with continuous tonometry and cardiac output devices. Gastric intramucosal pH (pHi), gastric-arterial carbon dioxide partial pressure difference (CO₂ gap), whole-body oxygen delivery (DO₂) and consumption (VO₂) and whole-body oxygen extraction fraction were measured at sequential time-points intraoperatively and up to 6 h postoperatively. Anaesthetic management was standardized. Results: Both groups had similar demographic makeup and extent of revascularization (ONCAB 2.6±0.9 grafts versus OPCAB 2.5±0.8 grafts; P=0.55). The ONCAB group had a mean (±SD) CPB time of 62±25 min and aortic cross-clamp time of 32±11 min. In both groups there was a similar and progressive drop in pHi intraoperatively. Postoperatively, there was a gradual separation between the groups with ONCAB patients showing no further decline in pHi, while further deterioration was observed in the OPCAB group up to 6 h postoperatively. There was a significant difference between the groups over time (P=0.03). There was a corresponding progressive rise in CO₂ gap perioperatively in both groups, with ONCAB patients demonstrating superior preservation of gastric mucosal oxygenation in the early postoperative period. Global oxygen utilization measurements showed superior DO₂ and VO₂ in the OPCAB group throughout the study. Conclusions: Despite superior global oxygen flux associated with beating-heart revascularization, gastric mucosal hypoxia occurred to similar extents in both groups with worsening trends for the OPCAB patients postoperatively. The splanchnic pathophysiology during beating-heart revascularization should be further explored.

Key Words: Cardiopulmonary bypass • Off-pump surgery • Gut • Gastric mucosal oxygenation • Tonometry

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