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Ann Thorac Surg 2002;74:S1348-S1352
© 2002 The Society of Thoracic Surgeons

Supplement: Cardiothoracic Techniques and Technologies

Acute effects of beating heart coronary surgery on left ventricular performance

Lucia Torracca, MDa*, Jan J. Schreuder, MD, PhDa, Andrea Quarti, MDa, Gennaro Ismeno, MDa, Vincenzo Franzé, MDa, Ottavio Alfieri, MDa

a Cardiac Surgery, San Raffaele University Hospital, Milan, Italy

* Address reprint requests to Dr Torracca, Via Olgettina 60, 20132 Segrate, Milan, Italy
e-mail: lucia.torracca{at}hsr.it

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

BACKGROUND: The increasing use of off-pump bypass grafting (OPCABG), requires an evaluation of its effects on left ventricular (LV) performance.

METHODS: In 8 patients with multivessel coronary disease who were undergoing to off-pump coronary artery bypass grafting, LV performance was analyzed from the pressure–volume (P-V) plane by the conductance catheter technique. Measurements were performed at base line, after the exposure of the vessels, after the application of the stabilization system, and at the end of the procedure.

RESULTS: No significant changes in heart rate, LV end-systolic volume, LV end-diastolic pressure, mean pulmonary artery, and mean systemic blood pressure were observed in the various stages of the procedure. Cardiac index decreased during left anterior descending coronary artery grafting after application of the stabilizer with a concomitant decrease in LV end-diastolic volume, together with decreases in LV peak negative -dP/dt and increases in {tau}, indicating an impairment of LV relaxation but without a change in preload recruitable stroke work, indicating preserved LV contractile state. Exposure of posterior and lateral vessels induced a decrease in cardiac index and preload recruitable stroke work without a decrease in LV preload, indicating a decrease in LV contractile state together with a decrease in peak -dP/dt and increase in {tau}, indicating an impairment in LV relaxation

CONCLUSIONS: Off-pump coronary artery bypass grafting can be performed without decreasing LV performance. Major cardiac displacement like that used for posterior and lateral exposure induces acutely significant decrease in LV contractile state.




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