Regional Left Ventricular Systolic Function in Humans During Off-Pump Coronary Bypass Surgery

Abstract

Background —Controversy exists as to whether off-pump CABG with local occlusion results in clinically significant myocardial ischemia during the occlusion period. This study was undertaken to delineate the effects of transient local coronary artery occlusion on regional systolic function. Methods and Results —Eight consenting patients undergoing left internal mammary to left anterior descending coronary artery (LAD) bypass were instrumented with a left ventricular pressure catheter and 2 subepicardial cylindrical ultrasonic dimension transducers placed in the minor axis dimension in the region served by the LAD. A digital sonomicrometer was used to collect data before, during, and after coronary occlusion from which percent systolic shortening and pressure-dimension loops were derived. Measuring devices were removed immediately after the final time point. All patients tolerated the procedure well, and there were no complications. Average duration of local occlusion needed for CABG was 15.9±4.4 minutes (range, 12 to 26 minutes). Local occlusion was associated with a decrease in peak systolic shortening from 5.8±0.8% to 1.8±0.8%. In all cases, function returned to baseline after restoration of flow. Pressure-dimension loops confirmed these findings and no evidence of diastolic creep. Linear repression analysis of degree of stenosis versus change in segmental shortening revealed a significant inverse correlation. Conclusions —Local occlusion of the LAD resulted in a transient decrease in myocardial function during occlusion with complete recovery during reperfusion. This change was less significant with increasing degrees of coronary stenosis. These data suggest that local occlusion is not associated with permanent myocardial injury but that ischemic changes do occur that may be clinically significant, especially in patients with lesser degrees of coronary stenosis.

Off-pump Coronary Artery Bypass is a Safe Option in Patients Presenting as Emergency

“…Additionally, the extended phases of hypotension and decreased cardiacoutput may occur which may, in turn, lead to compromised haemodynamics and cardiac decompensation. 15,16 For this reason, surgeons have been cautious to expose emergency patients to this technique, which may put patients at risk for emergent conversion to CPB, and subsequently leading to the damage of multiple organs. In contrast, the current data demonstrate that OPCAB is generally associated with less major complications, and risk-adjusted reduced mortality.…”