医学
血流动力学
心脏病学
肺楔压
中心静脉压
内科学
围手术期
非体外循环冠状动脉搭桥术
吻合
麻醉
动脉
外科
血压
心率
旁路移植
作者
Jan‐Michael Abicht,Andrés Beiras-Fernández,Dominik Bengel,Calin Vicol
出处
期刊:Heart Surgery Forum
[Carden Jennings Publishing Co.]
日期:2012-08-23
卷期号:15 (4): 224-224
被引量:6
标识
DOI:10.1532/hsf98.20121028
摘要
Displacement of the heart to expose the posterior vessels during off-pump coronary artery bypass (OPCAB) may cause hemodynamic instability. Deep pericardial traction suture (DPTS) and vacuum-assisted apical suction (VAS) with the Starfish positioning device help to provide good exposure without relevant hemodynamic changes. Our aim was to compare these two methods in patients undergoing multivessel OPCAB.We prospectively randomized 20 patients undergoing multivessel OPCAB to the use of VAS or DPTS. The Octopus device was used in both groups to stabilize the target vessel. Hemodynamic parameters, including venous oxygen content (SvO(2)), cardiac index (CI), central venous pressure (CVP), mean arterial pressure (MAP), pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP), were measured before grafting (baseline), after heart positioning, and during performance of peripheral anastomoses.Perioperative data for the two groups were similar. During exposure of the lateral wall, there were fewer hemodynamic changes in the DPTS group (increase in CVP) than in the VAS group (increases in CVP, PAP, and PCWP); the CVP was significantly higher in the DPTS group (P < .05). During exposure of the posterior wall, significant hemodynamic changes occurred only in the DPTS group (increase in PCWP). Values for all other parameters were similar, including anastomosis time, graft flow, postoperative myocardial enzymes, and inotropic support.Heart positioning during OPCAB with either VAS or DPTS is a safe and effective maneuver for exposure of coronary arteries. In our study, the use of the VAS device produced less hemodynamic impairment during exposure of the lateral and posterior walls.
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