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Eur J Cardiothorac Surg 2004;25:26-34
© 2004 Elsevier Science NL

Analysis of thoracic aortic blood flow during off-pump coronary artery bypass surgery

^a Service d'anesthésie-réanimation cardiologique, Hopital cardiologique, CHRU de Lille, France
^b Service de chirurgie cardiovasculaire, Pr. Henri Warembourg, Hopital Cardiologique, CHRU de Lille, France
^c The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK

Received 21 May 2003; received in revised form 24 September 2003; accepted 28 September 2003.

^* Corresponding author. MRS Unit, Harefield Hospital, Middlesex UB9 6JH, UK. Tel.: +44-79-68-025-332; fax: +44-1895-828-684
e-mail: sharifalruzzeh{at}hotmail.com

Objectives: The non-invasive monitoring of thoracic aortic blood flow (TABF) during off-pump coronary artery bypass (OPCAB) surgery is becoming more commonly used and proved to be invaluable in the early detection of haemodynamic compromise due to heart displacement. The aim of this study was to analyze the changes in the TABF during OPCAB using transoesophageal Doppler and compare them with the changes observed by other monitoring methods as cardiac output, invasive pulmonary and radial pressures and mixed venous oxygen saturation. Methods: The measurements obtained from classic haemodynamic monitoring methods including the radial artery line and the pulmonary artery catheter with continuous monitoring of the cardiac output and mixed venous blood oxygen saturation were compared to the measurements of TABF obtained from a transoesophageal Doppler probe in 15 consecutive patients who underwent OPCAB surgery. Results: The TABF decreased significantly during the construction of coronary anastomoses from 3.42±0.94 l/min (baseline) to 2.2±0.8 l/min during the first coronary anastomosis and then to 2.14±1.12 l/min during the second coronary anastomosis (F=4.29, P=0.008). TABF returned to the baseline values (2.85±1.19 l/min) at chest closure. The cardiac output measurement showed no significant decrease compared to baseline. Conclusions: Low TABF occurred without significant changes in the measurements obtained from classic haemodynamic monitoring methods during OPCAB surgery. This finding could be of vital importance in helping improve the monitoring and consequently the management of patients undergoing OPCAB surgery.

Key Words: Off-pump surgery • Transoesophageal Doppler • Thoracic aortic blood flow

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