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Eur J Cardiothorac Surg 2001;20:216
© 2001 Elsevier Science NL

Letter to the Editor

Reply to Ngaage

Ian Ryder, Raimondo Ascione, G.D. Angelini

Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK

Received 29 March 2001; accepted 4 April 2001.

Corresponding author

We thank Mr Ngaage for his interest in our study.

We stand by our conclusions, as we clearly state in the penultimate paragraph that hearts with left ventricular dysfunction were excluded from this study because our purpose was to investigate the exclusive effects of positioning of the heart during OPCAB. We can however confirm that, in our experience, patients with poor left ventricular function generally tolerate OPCAB surgery well.

We agree that measuring continuous cardiac output would have been an advantage. However Seigel et al. [1] have documented a response time of 7.3±2.3 min for a clinically significant difference (20%) in cardiac output using the continuous cardiac out put pulmonary artery catheter. Since it takes only a minute or so to manoeuvre the heart into position and apply the stabiliser, and an average of 8 min to complete the anastomoses, this response time is too slow. In order to ‘capture’ the short lived changes in cardiac out put associated with OPCAB we believe that rapid intermittent injections remain the most appropriate method when using a pulmonary artery catheter.

References

  1. Siegel L.C., Hennesy M.M., Pearl R.G. Delayed time response of the continuous cardiac output pulmonary artery catheter. Anesth Analg 1996;83:1173-1177.[Abstract]




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