Ammannaya Ganesh Kumar K, Basantwani Shakuntala, Mishra Prashant, Khandekar Jayant V
Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.
Kardiochir Torakochirurgia Pol. 2019 Jul;16(2):69-73. doi: 10.5114/kitp.2019.86358. Epub 2019 Jun 28.
Significant hemodynamic derangements can occur during off-pump coronary artery bypass graft (OPCAB) surgery resulting from the displacement of the beating heart, which may necessitate conversion to on-pump surgery.
We proposed to evaluate the alterations in hemodynamic parameters in patients during the course of anastomosis in OPCAB surgery using the Octopus tissue stabilizer.
In 100 consecutive patients undergoing OPCAB surgery, hemodynamic variables including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded at baseline, during each coronary artery anastomosis at 2 min, 10 min and after release of the Octopus tissue stabilizer.
CO decreased significantly after target stabilization and during all coronary anastomoses (5.42 ±1.1 l/min at baseline, 4.26 ±1.02 l/min at 2 min and 3.92 ±0.98 l/min at 10 min; < 0.001), with the greatest decrease noted during obtuse marginal (OM) branch of left circumflex artery anastomosis (3.67 ±0.86 l/min at 2 min and 3.38 ±0.78 l/min at 10 min). Inotropic drugs were required to maintain mean arterial pressure (MAP) > 60 mm Hg in 43 patients, which was most frequently noted during OM anastomosis ( < 0.001). The incidence of bradycardia requiring inotropes was noted to be the highest during left anterior descending (LAD) artery anastomosis ( = 0.002).
During OPCAB surgery using the Octopus for coronary target stabilization, CO decreased the most during OM anastomosis requiring inotropes, while bradycardia was most frequent during LAD anastomosis. Careful monitoring and management of hemodynamic variables are therefore of utmost importance to avoid conversion to on-pump surgery.
非体外循环冠状动脉搭桥术（OPCAB）手术过程中，跳动心脏的移位可导致显著的血流动力学紊乱，这可能需要转为体外循环手术。
我们旨在评估使用章鱼组织稳定器进行OPCAB手术时患者在吻合过程中血流动力学参数的变化。
连续100例接受OPCAB手术的患者，在基线、每次冠状动脉吻合2分钟、10分钟时以及松开章鱼组织稳定器后，记录包括心输出量（CO）、心率（HR）、平均动脉压（MAP）和中心静脉压（CVP）在内的血流动力学变量。
目标稳定后及所有冠状动脉吻合期间，CO显著下降（基线时为5.42±1.1升/分钟，2分钟时为4.26±1.02升/分钟，10分钟时为3.92±0.98升/分钟；P<0.001），在左旋支钝缘支（OM）吻合期间下降最为明显（2分钟时为3.67±0.86升/分钟，10分钟时为3.38±0.78升/分钟）。43例患者需要使用血管活性药物维持平均动脉压（MAP）>60mmHg，这在OM吻合期间最为常见（P<0.001）。需要血管活性药物的心动过缓发生率在左前降支（LAD）动脉吻合期间最高（P = 0.002）。
在使用章鱼进行冠状动脉目标稳定的OPCAB手术中，OM吻合需要血管活性药物时CO下降最多，而LAD吻合期间心动过缓最为频繁。因此，仔细监测和管理血流动力学变量对于避免转为体外循环手术至关重要。
