Cardiac output monitoring during off-pump coronary artery bypass grafting

Objective: To evaluate and compare monitors of cardiac output during repositioning and stabilization of the heart for off-pump coronary artery bypass (OPCAB) surgery. Design: Prospective, observational, clinical study. Setting: University teaching hospital. Participants: Consecutive patients schedul...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2004-02, Vol.18 (1), p.43-46
Main Authors: Grow, Matthew P, Singh, Amrik, Fleming, Neal W, Young, Nilas, Watnik, Mitchell
Format: Article
Language:English
Subjects:
Aged
anesthesia
Blood Flow Velocity - physiology
Blood Pressure - physiology
bypass
cardiac output
Cardiac Output - physiology
cardiac surgery
Catheterization, Swan-Ganz
Coronary Artery Bypass
Echocardiography, Transesophageal
Female
Heart Rate - physiology
Humans
Male
Models, Biological
Monitoring, Intraoperative - instrumentation
Monitoring, Intraoperative - methods
off-pump
Oxygen - blood
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
transesophageal echocardiography
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Summary:Objective: To evaluate and compare monitors of cardiac output during repositioning and stabilization of the heart for off-pump coronary artery bypass (OPCAB) surgery. Design: Prospective, observational, clinical study. Setting: University teaching hospital. Participants: Consecutive patients scheduled to undergo elective OPCAB (n = 19). Interventions: Monitoring, induction, and anesthesia followed a routine protocol for coronary artery bypass patients. This included the use of transesophageal echocardiography (TEE) and pulmonary artery catheter placement. Measurements and Main Results: After positioning and stabilization for OPCAB surgery, the changes in descending aortic flow velocity (VTI) times heart rate (HR) and the mixed venous oxygen saturation (SvO 2) could be used to predict the changes in thermodilution cardiac output (TDCO) using the following model: Δ TDCO ( calc) =−13.15+0.35(Δ VTI∗ HR)+0.61(Δ SvO 2) where Δ indicates the percentage change from baseline values. The changes in mean arterial pressure, mean pulmonary artery pressure, and continuous cardiac output did not correlate with the changes in TDCO. Conclusion: The use of the VTI∗HR, as determined by TEE, in addition to the SvO 2 can strengthen clinical decision making during repositioning and stabilization of the heart during OPCAB. Changes in the VTI∗HR and SvO 2 can be used as surrogate markers for changes in CO during OPCAB surgery.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2003.10.009