Hemodynamic changes of the right ventricle during off-pump coronary bypass grafting
- VernacularTitle:非体外循环冠状动脉旁路移植术对右心室血流动力学的影响
- Author:
Huishan WANG
;
Zengwei WANG
;
Hongyu ZHU
- Publication Type:Journal Article
- Keywords:
Off-pump;
Coronary artery bypass grafting;
Right ventricle;
Hemodynamics
- From:
Chinese Journal of Minimally Invasive Surgery
2001;0(04):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe functional changes of the right ventricle (RV) during off-pump coronary bypass grafting (OPCABG) by using a continuous cardiac output (CCO) monitoring. Methods The study included 178 patients with 2~3 vessel disease requiring a coronary bypass grafting. Preoperative cardiac functions were classified as New York Heart Association (NYHA) class Ⅱ in 72 patients, class Ⅲ in 84 patients and class Ⅳ in 22. The ejection fraction of the left ventricle was 0.35~0.82. The mean number of bypassed vessel was 3.3. A Swan-Ganz catheter was inserted for continuous monitoring of cardiac output by thermodilution. Parameters measured were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), mixed venous saturation value (SvO_2), right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume index (RVESVI), and right ventricular end-diastolic volume index (RVEDVI). The hemodynamic parameters were measured at time-points when a stable hemodynamics was obtained after the induction of general anesthesia and before the heart would be moved (T1), when the anterior descending branch would be anastomosed (T2), when the circumflex branch or the diagonal branch would be anastomosed (T3), when the right coronary artery or the posterior descending branch would be anastomosed (T4), and when the heart had been repositioned before the thoracic cavity would be closed (T5), respectively. Results There were 4 fatal cases: 2 patients received an emergency surgery for acute myocardial infarction and died with severe low cardiac output syndrome 3 days after the surgery, 1 patient ended with severe respiratory failure 7 days after the surgery, and 1 succumbed to acute pulmonary embolism 4 days after the surgery. As compared with the time-point of T1: the MPAP, PCWP, RAP and PVRI were significantly elevated and the SvO_2 was significantly reduced at the time-point of T2; the MPAP, PCWP, RAP, PVRI and SVRI were significantly elevated and the SvO_2, CI, SVI and RVEF were significantly depressed at the time-point of T3; the HR and RAP significantly went up and the SvO_2 significantly dropped at the time-point of T4; the parameters didn’t recover to normal levels at the time-point of T5. Conclusions When the obtuse marginal (OM) branch is anastomosed, right ventricular functions may decrease, particularly in CI and RVEF levels, while when the left anterior descending branch or right coronary artery is anastomosed, hemodynamics of the right ventricle vary within narrow limits. Therefore, a monitoring of right ventricular functions during OPCABG is of great significance, especially for those with right ventricular insufficiency.
