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Eur J Cardiothorac Surg 2004;25:572-577
© 2004 Elsevier Science NL
a Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
b Department of Anesthesiology and Pain Medicine, Konyang University School of Medicine, Daejeon, South Korea
c Department of Cardiac Surgery, Yonsei University College of Medicine, Seoul, South Korea
Received 13 November 2003; received in revised form 29 December 2003; accepted 9 January 2004.
* Corresponding author. Tel.: +82-2-361-7292; fax: +82-2-364-2951
e-mail: ywhong{at}yumc.yonsei.ac.kr
Objectives: Hemodynamic derangement during displacement of beating heart in off-pump coronary artery bypass graft (OPCAB) surgery might be related with right ventricular (RV) dysfunction. We evaluated RV function and hemodynamic alterations using a thermodilution pulmonary artery catheter. Methods: The study included 30 patients undergoing OPCAB, using single pericardial suture and tissue stabilizer. A thermodilution pulmonary artery catheter for continuous monitoring of the cardiac output (CO), right ventricular ejection fraction (RVEF) and RV volume was inserted before anesthesia. The hemodynamic variables were measured after the induction of anesthesia, 5 min after the heart was positioned for each coronary anastomosis and after the sternum was closed. Results: There was no significant change in the RVEF and cardiac index during anastomosis of the left anterior descending artery and right coronary artery. However, the significantly reduced RVEF accompanied by an increase in RV afterload and decrease in the CO was observed during anastomosis of the obtuse marginal (OM) artery. RV volumes did not significantly change during anastomoses, though the right atrial pressure increased during anastomoses of all coronary arteries. Conclusions: The displacement of beating heart for positioning during anastomosis of the graft to OM artery caused significant derangement of RV function and decrease in CO. A thermodilution catheter continuously measuring the CO and RVEF was useful to monitor the change in RV function and volume during OPCAB.
Key Words: Off-pump coronary artery bypass grafting • Right ventricular ejection fraction • Thermodilution pulmonary artery catheter • Right heart function
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