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Right arrow Coronary disease

Ann Thorac Surg 2005;79:2004-2012
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Do Coronary Bypass Graft Flows Differ Between On-Pump and Off-Pump Operations?

Yves A.G. Louagie, MD, PhDa,*, Jacques Jamart, MDb, André Gruslin, ECCPc

a Department of Cardiovascular and Thoracic Surgery University Clinics of Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium
b Department of Biostatistics University Clinics of Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium
c Department of the Perfusion Unit, University Clinics of Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium

Accepted for publication November 17, 2004.

* Address reprint requests to Prof Louagie, Cardiovascular and Thoracic Surgery, University Clinics of Mont Godinne, 1 av Therasse, B-5530 Mont Yvoir, Belgium (E-mail: louagie{at}chir.ucl.ac.be).

BACKGROUND: The aim of this study is to compare hemodynamic factors in coronary bypass grafts on-pump and off-pump.

METHODS: Two propensity score-matched groups of 89 patients each including 408 dual beam Doppler flow measurements were compared. The study included only patent and single terminolateral bypass grafts.

RESULTS: Flow was 64.9 ± 37.3 mL/min in the on-pump group versus 58.6 ± 35.0 mL/min in the off-pump group (p = 0.063); velocity was 23.8 ± 10.5 versus 20.5 ± 10.4 cm/s (p = 0.004); resistance measured as mm Hg/(mL/min–1) was 1.50 ± 1.09 versus 1.76 ± 1.14 (p = 0.020); pulsatility index was 1.98 ± 1.52 versus 2.44 ± 1.62 (p = 0.004). The hematocrit was 23.5 ± 3.8% in the on-pump and 32.9 ± 4.1% in the off-pump groups (p < 0 0.001). Multivariate analysis showed that hematocrit was the most significant factor influencing flow (p < 0.001) and velocity (p < 0.001), along with resistance (p = 0.004) and pulsatility index (p < 0.001). In a subset of 50 hemodynamic measurements made on left internal thoracic arteries implanted onto left anterior descending arteries and matched for hematocrit, there were no differences between on-pump and off-pump groups regarding flow, velocity, resistance, or pulsatility index.

CONCLUSIONS: Off-pump compared with on-pump bypass surgery is associated with lower velocity and higher resistance in the grafts, mainly caused by changes in hematocrit and viscosity related to hemodilution.




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