Analysis of hemodynamic changes during beating heart surgical procedures

Mathison, Megumi; Edgerton, James R.; Horswell, Jeffrey L.; Akin, Jodi J.; Mack, Michael J.

doi:10.1016/s0003-4975(00)01590-3

Cited by 168 publications

(119 citation statements)

References 12 publications

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“…22 In this study, because of the presence of the ED probe, we could not use intraoperative transesophageal echocardiography to document the presence of TR. While right heart compression and/or diastolic dysfunction have been documented in OPCAB, 23,24 acute TR has never been demonstrated during this type of surgery. The loss of contact between heart and esophagus during ante-rior 90° cardiac displacement, which could very well be associated with TR, makes this diagnosis hard to prove.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Doppler and thermodilution are not interchangeable for determination of cardiac output

Collins

Girard

Boudreault

et al. 2005

Can J Anesth/J Can Anesth

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Purpose: This study compares thermodilution cardiac output (TD-CO) and esophageal Doppler cardiac output (ED-CO) during periods of hemodynamic stability and after heart stabilization during off-pump coronary artery bypass (OPCAB) surgery. Methods:After Institutional Review Board approval, 58 patients undergoing OPCAB had simultaneous comparison of TD-CO and ED-CO at three time periods. Measurements were recorded, in a blinded manner, after probe insertion (T0), immediately before and after (T1,T2) heart displacement and before starting any pharmacological treatment (if needed) to maintain systolic blood pressure to its value before heart mobilization. Measurements were also taken before sternal closure (Tfinal).Results: Three hundred and two pairs of data were analyzed using the Bland and Altman method. Bias, standard deviation (SD) of the bias (precision), and degree of agreement (bias ± 2 SD) were calculated. Based on published literature, we considered that the highest degree of agreement should be < 0.5 L·min -1 to consider both methods as interchangeable. At T0, bias and SD of bias between TD-CO and ED-CO were -0.1 ± 1.0 L·min -1 . Immediately before heart stabilization, bias ± SD was 0.6 ± 1.0 L·min -1 and after heart displacement, 0.5 ± 0.8 L·min Conclusion:Because the degree of agreement was > 0.5 L·min -1 at all measurement periods except T0, we conclude that TD and ED are not interchangeable at any time during OPCAB surgery. Objectif : Comparer le débit cardiaque obtenu par thermodilution (DC-TD) à celui du Doppler oesophagien (DC-DO) pendant la stabilité hémodynamique et après la stabilisation cardiaque au cours d'un pontage aortocoronarien à coeur battant (PACCB). Méthode : Avec l'approbation du Comité de révision, nous avons recruté 58 patients devant subir un PACCB pour une comparaison simultanée du DC-TD et DC-DO à trois moments différents. Les mesures ont été enregistrées à l'aveugle, après l'insertion de la sonde (T0), immédiatement avant et après (T1,T2) le déplacement

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Section: Discussionmentioning

confidence: 99%

Esophageal Doppler and thermodilution are not interchangeable for determination of cardiac output

Collins

Girard

Boudreault

et al. 2005

Can J Anesth/J Can Anesth

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“…10,12 However, the CSRS database contains detailed information on coronary anatomy and this information was included in our multivariate models.…”

Section: Discussionmentioning

confidence: 99%

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Mukamel

Glance

Weimer

et al. 2007

J Health Serv Res Policy

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Objective-To examine explanations of differences in utilization rates of a newly reintroduced technique -off-pump coronary artery bypass grafting (CABG) -between racial minorities and Whites.Method-The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of offpump versus on-pump surgery.Results-Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent offpump CABG (P < 0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks

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“…19 Circumflex positioning resulted in a decrease in mean arterial pressure of 22.2 ± 4.4% and Before Octopus 3.3 ± 1.1 2.6 ± 0.5 2.9 ± 0.6 2.8 ± 0.6 During Octopus 3.1 ± 0.9 2.5 ± 0.4 2.6 ± 0.6 2.8 ± 0.5 After Octopus 3.1 ± 0.9 2.6 ± 0.4 2.5 ± 0.5 3.1 ± 0.7…”

Section: Figurementioning

confidence: 99%

“…With the Octopus system, circumflex positioning demonstrated the largest hemodynamic compromise, because the right ventricle is more compressed than the left ventricle, causing a disturbance in diastolic distention. 19 Moreover, with anterior dislocation of the heart, the heart is folded causing a flow obstruction. Contrary to this technique, the verticalization method used at the Montreal Heart Institute does not rely on the dislocation of the heart by the stabilizer.…”

Section: Dopamine Requiredmentioning

confidence: 99%

“…Volume loading, Trendelenburg position, and vasopressor infusion usually correct these derangements, although the RV assist device has been proposed for unstable patients. 19 TEE is indicated in patients who are not responsive to the above treatment and helps to differentiate between cardiac dysfunction and extracardiac compression.…”

Section: Diastolic Dysfunctionmentioning

confidence: 99%

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Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

Couture

Denault

Limoges

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the mechanisms of hemodynamic changes during off-pump coronary artery bypass graft surgery (OP-CABG).S So ou ur rc ce e: : Pertinent medical literature in the English and French languages was identified through a Medline computerized literature search and a manual search of selected articles, using off-pump coronary artery surgery, beating heart surgery, hemodynamic, and transesophageal echocardiography as key words. Human and animal studies were included. P Pr ri in nc ci ip pa al l f fi in nd di in ng g: : Hemodynamic variations in OP-CABG may be due to mobilization and stabilization of the heart, or myocardial ischemia occurring during coronary occlusion. Suction type and compression type stabilizers produce hemodynamic effects through different mechanisms. Heart dislocation (90° anterior displacement) and compression of the right ventricle to a greater extent than the left ventricle are responsible for hemodynamic alterations when using suction type stabilizers. Compression of the left ventricular outflow tract and abnormal diastolic expansion secondary to direct deformation of the left ventricular geometry are proposed mechanisms for hemodynamic derangements with compression type stabilizer. Coronary occlusion during the anastomosis can have additional effects on left ventricular function, depending on the status of collateral flow. The value and limitations of electrocardiographic (ECG), hemodynamic and echocardiographic monitoring modalities during OP-CABG are reviewed.C Co on nc cl lu us si io on ns s: : In summary, hemodynamic changes which can either be secondary to the stabilization technique or to transient ischemia represent an important diagnostic challenge during offbypass procedures. The mechanism can vary according to the stabilization system. Current monitoring such as ECG and hemodynamic monitoring are used but remain limited in establishing the cause of hemodynamic instability. Transesophageal echocardiography is used in selected patients to diagnose the etiology of hemodynamic instability and can direct therapy, particularly in those with severe myocardial systolic and diastolic dysfunction, mild to moderate mitral regurgitation, or for patients who are unstable during the procedure. Objectif : Décrire les mécanismes de changements hémodynamiques pendant le pontage aortocoronarien (PAC-CB). Source : La documentation pertinente en anglais et en français a été

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Analysis of hemodynamic changes during beating heart surgical procedures

Cited by 168 publications

References 12 publications

Esophageal Doppler and thermodilution are not interchangeable for determination of cardiac output

Esophageal Doppler and thermodilution are not interchangeable for determination of cardiac output

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

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