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Eur J Cardiothorac Surg 2005;27:289-295
© 2005 Elsevier Science NL

Dobutamine improves thoracic aortic blood flow during off-pump coronary artery bypass surgery: results of a prospective randomised controlled trial

^a Service de Chirurgie Cardiovasculaire, Pr. H. Warembourg, Hopital Cardiologique, CHRU de Lille, France
^b The National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK

Received 12 July 2004; received in revised form 16 October 2004; accepted 31 October 2004.

^* Corresponding author. Tel.: +33 3 2044 5028; fax: +33 3 2044 6992. (E-mail: g-fayad{at}chru-lille.fr).

Objective: Dobutamine is commonly used to improve ventricular performance in cardiac surgery. The aim of this prospective randomised controlled study was to assess the effectiveness of using low doses of dobutamine during off-pump coronary artery bypass (OPCAB) surgery in order to reduce haemodynamic compromise due to heart displacement. Methods: Thirty-two patients undergoing elective coronary artery bypass grafting (CABG) surgery using OPCAB technique for more than two vessels were approached and recruited. We analysed the changes in the thoracic aortic blood flow (TABF) during OPCAB using transoesophageal Doppler and by other conventional monitoring methods as cardiac output, invasive pulmonary and radial pressures and mixed venous oxygen saturation. Results: The two groups were similar in preoperative characteristics. No postoperative complications were observed in the study patients. The heart rate, right atrial pressure, cardiac output measured by thermodilution and TABF changed significantly during the procedure. Also significant changes in descending thoracic aortic diameter were observed. The postoperative creatinine was significantly lower in the dobutamine group (P=0.04). Dobutamine was found responsible for the improvement in the descending TABF (P=0.006). Conclusions: This study showed that intra-operative intravenous infusion of dobutamine at 5µg/kg per min in routine OPCAB patients safely increased cardiac output even without such changes been detected by conventional monitoring methods.

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