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Ann Thorac Surg 2000;70:1355-1360
© 2000 The Society of Thoracic Surgeons
a Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA
Address reprint requests to Dr Mathison, MCVI Research and Outcomes, 8900 N Kendall Dr, Miami, FL 33176
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. Coronary artery bypass grafting on the beating heart causes significant hemodynamic compromise during displacement of the heart. The precise mechanisms causing altered hemodynamics have not been clearly understood. The purpose of this study was to define the hemodynamic changes caused by displacing the heart in patients undergoing beating heart surgical procedures.
Methods. Forty-four patients (35 men, 9 women; mean age, 64.5 ± 9.6 years) underwent off-pump coronary artery bypass grafting. The hemodynamic variables were collected before and after positioning the heart for anastomosis of the left anterior descending, circumflex, and posterior descending coronary arteries.
Results. There was a significant increase in right ventricular end-diastolic pressure during positioning for all vessels, and in left ventricular end-diastolic pressure during positioning for the left anterior descending and circumflex coronary arteries. Positioning for the circumflex artery showed the largest increase of left and right ventricular end-diastolic pressure, resulting in the greatest hemodynamic compromise.
Conclusions. In the clinical setting of diseased human hearts, there is a biventricular contribution to altered hemodynamics. The increase of right ventricular end-diastolic pressure in all positions suggests that the major cause of hemodynamic changes is disturbed diastolic filling of the right ventricle, especially by direct ventricular compression.
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Ann. Thorac. Surg. 2000 70: 1360-1361.
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