Kunigo Tatsuya, Yoshikawa Yusuke, Yamamoto Shuji, Yamakage Michiaki
Department of Anesthesiology, Obihiro Kosei General Hospital, 1 West 14 South 10, Obihiro, Hokkaido, 080-0024, Japan.
Department of Anesthesiology, Sapporo Medical University School of Medicine, 291 South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Gen Thorac Cardiovasc Surg. 2021 Jun;69(6):934-942. doi: 10.1007/s11748-020-01557-2. Epub 2021 Jan 3.
The association of preoperative RV function with hemodynamics during OPCAB or emergency conversion is not clear. The aim of this study was to investigate the association of vasoactive-inotropic score with tricuspid annular plane systolic excursion and tricuspid regurgitation in off-pump coronary artery bypass grafting, and to calculate the optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion to cardiopulmonary bypass.
Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between April 2015 and March 2020 were enrolled in this study. We retrospectively assessed the association of intraoperative maximum "vasoactive-inotropic score", a weighted sum of various inotropes and vasoconstrictors, with tricuspid annular plane systolic excursion and tricuspid regurgitation. A receiver operating characteristic curve of conversion on tricuspid annular plane systolic excursion was also constructed.
135 patients were included in final analysis. Conversion was performed in 10 cases. Multiple regression analysis showed that tricuspid annular plane systolic excursion, mild or more tricuspid regurgitation and experienced surgeon were significantly related to vasoactive-inotropic score. The receiver operating characteristic curve to predict conversion by tricuspid annular plane systolic excursion showed an optimal cut-off value of 15.0 mm and area under the curve of 0.808.
Tricuspid annular plane systolic excursion and tricuspid regurgitation were associated with vasoactive-inotropic score in off-pump coronary artery bypass grafting. The optimal cut-off value of tricuspid annular plane systolic excursion to predict emergency conversion was 15 mm.
术前右心室功能与非体外循环冠状动脉搭桥术（OPCAB）期间或急诊转为体外循环时的血流动力学之间的关联尚不清楚。本研究旨在探讨血管活性-正性肌力评分与非体外循环冠状动脉搭桥术中三尖瓣环平面收缩期位移及三尖瓣反流的相关性，并计算三尖瓣环平面收缩期位移预测急诊转为体外循环的最佳截断值。
纳入2015年4月至2020年3月期间接受非体外循环冠状动脉搭桥术的20岁以上患者。我们回顾性评估术中最大“血管活性-正性肌力评分”（各种正性肌力药和血管收缩剂的加权总和）与三尖瓣环平面收缩期位移及三尖瓣反流的相关性。还构建了基于三尖瓣环平面收缩期位移的急诊转为体外循环的受试者工作特征曲线。
最终分析纳入135例患者。10例患者进行了急诊转为体外循环。多元回归分析显示，三尖瓣环平面收缩期位移、轻度及以上三尖瓣反流和经验丰富的外科医生与血管活性-正性肌力评分显著相关。基于三尖瓣环平面收缩期位移预测急诊转为体外循环的受试者工作特征曲线显示，最佳截断值为15.0 mm，曲线下面积为0.808。
在非体外循环冠状动脉搭桥术中，三尖瓣环平面收缩期位移及三尖瓣反流与血管活性-正性肌力评分相关。预测急诊转为体外循环的三尖瓣环平面收缩期位移的最佳截断值为15 mm。
