Effect of Off-pump Coronary Artery Bypass Grafting on the Intraoperative Hemodynamics

Abstract

Background: The hemodynamic instability during off-pump coronary bypass grafting (CABG) may impair the complete coronary revascularization. We evaluated the effect of off-pump CABG on intraoperative hemodynamic parameters. Aim of work: The purpose of this study is to assess the patients' hemodynamics during off-pump coronary artery bypass graft surgery. And the main challenge during the operation is to maintain hemodynamic stability during this procedure. Patient and Methods: We included 40 patients who underwent offpump CABG from 2017 to 2019. The mean age was 55.75± 6.73 years, and 28 patients were males (70%). The mean ejection fraction was 60.08 ± 3.81%. Study endpoints were the intraoperative hemodynamic parameters and postoperative complications. Results: Heart rate was significantly higher during the grafting of the posterior descending artery (PDA)(79.3± 2.8beats/min) and right coronary artery (79.5 ± 1.8 beats/min) compared to all other grafts (p<0.001). The highest central venous pressure(12.6± 1.2 mmHg)and mean pulmonary artery pressure (33.2± 1.4 mmHg) and the lowest mean arterial and pressure (68.1± 3.3 mmHg) were recorded during PDA grafting (p<0.001, for all parameters). There was no significant difference in adrenaline dose infused during the anastomosis of all grafts (p= 0.2). Ejection fraction significantly decreased predischarge (52.18 ± 2.58 %) and at 6 months (52.83 ± 3.57%) compared to the preoperative value (p<0.001). Conclusion: Off-pump CABG was associated with significant hemodynamic instability, which was more evident during the posterior descending artery grafting. Proper anesthetic management and fluid infusion are required, especially during the anastomosis of the right and posterior coronary systems.