Bm Ajith, Raman Rajesh, Prabha Rati, Kaushal Dinesh, Kaushik Karan, Rahul Kumar, Tewarson Vivek
Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND.
Department of Anesthesiology, King George's Medical University, Lucknow, IND.
Cureus. 2024 Nov 4;16(11):e73011. doi: 10.7759/cureus.73011. eCollection 2024 Nov.
There is a lack of information about the left ventricle (LV) systolic function changes during pump-assisted beating heart coronary artery bypass graft surgery (PACAB). This study aimed to study the changes in LV systolic function changes during PACAB.
In this prospective, single-arm, observational study, 70 patients with American Society of Anesthesiologists physical status III or IV of either sex, aged 40-70 years, scheduled to undergo elective PACAB for isolated ischemic heart disease with EF >30% were included. We excluded patients with pregnancy, pericardial effusion, contraindications to transesophageal echocardiography (TEE), regional wall-motion abnormality of basal LV segments, pericardial effusion, right ventricular dysfunction, bundle branch blocks, and atrial fibrillation. After standard anesthesia induction, patients underwent PACAB. LV ejection fraction (EF), mitral annular plane systolic excursion (MAPSE), and tissue Doppler-derived peak mitral annular systolic velocity (s') were recorded at various time points of surgery. Change in LV EF during surgery was the primary outcome variable of the study. Secondary outcome variables were complications and changes in MAPSE and s'. A repeated measure analysis of variance was used to compare the changes in LV systolic function at various stages of surgery.
Baseline LV EF was 47.73±9.91%. Compared to baseline, changes in EF during and after the surgery were not statistically and clinically significant. Changes in MAPSE and s' during the surgery were not statistically significant. Complications included postoperative acute kidney injury, stroke, excess bleeding, and pneumonia.
LV systolic function does not vary significantly during PACAB. However, more extensive randomized trials are required to apply these findings for routine use.
关于在泵辅助跳动心脏冠状动脉搭桥手术（PACAB）期间左心室（LV）收缩功能变化的信息匮乏。本研究旨在探讨PACAB期间LV收缩功能的变化。
在这项前瞻性、单臂、观察性研究中，纳入了70例年龄在40 - 70岁之间、美国麻醉医师协会身体状况为III或IV级、计划因单纯缺血性心脏病接受择期PACAB且射血分数（EF）>30%的患者，无论性别。我们排除了妊娠、心包积液、经食管超声心动图（TEE）禁忌症、左心室基底段节段性室壁运动异常、心包积液、右心室功能障碍、束支传导阻滞和心房颤动的患者。在标准麻醉诱导后，患者接受PACAB。在手术的不同时间点记录左心室射血分数（EF）、二尖瓣环平面收缩期位移（MAPSE）和组织多普勒衍生的二尖瓣环收缩期峰值速度（s'）。手术期间左心室EF的变化是本研究的主要结局变量。次要结局变量是并发症以及MAPSE和s'的变化。采用重复测量方差分析来比较手术各阶段左心室收缩功能的变化。
基线左心室EF为47.73±9.91%。与基线相比，手术期间和术后EF的变化在统计学和临床上均无显著意义。手术期间MAPSE和s'的变化无统计学意义。并发症包括术后急性肾损伤、中风、出血过多和肺炎。
在PACAB期间左心室收缩功能无显著变化。然而，需要更广泛的随机试验才能将这些发现应用于常规使用。
