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Sunil K Ohri
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ORIGINAL ARTICLE

Hemodynamic Advantages of Right Heart Decompression during Off-Pump Surgery

Theodore Velissaris, FRCS (C-Th), Max M Jonas, FRCA1, Sunil K Ohri, FRCS (C-Th)

Department of Cardiothoracic Surgery
1 Department of Anesthesiology, Southampton University Hospital, Southampton, UK

Theodore Velissaris, FRCS (C-Th), Tel: +44 23 80796234, Fax: +44 23 80798508, Email: theovelissaris{at}googlemail.com, Department of Cardiothoracic Surgery, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.

ABSTRACT

Cardiac maneuvering during off-pump coronary artery bypass surgery can compress the right ventricle, causing temporary dysfunction and hemodynamic instability. The hemodynamic impact of a decompression technique comprising right pleurotomy and pericardial release was investigated during cardiac elevation. Intraoperative continuous real-time monitoring of cardiac index and stroke volume index was carried out using the PulseCO system in 12 consecutive patients with normal ventricular function who underwent off-pump coronary artery bypass by a single surgeon. A pulmonary artery catheter was used to monitor pulmonary artery pressure and systemic venous O2 saturation. Hemodynamic changes during vertical displacement of the heart were measured before and after performing a right pleurotomy and pericardial release. Following right heart decompression, stroke volume index, cardiac index, mean arterial pressure, and systemic venous O2 saturation were significantly better preserved during cardiac elevation. This demonstrates that right heart decompression via pleurotomy and pericardial release significantly improves hemodynamic stability during cardiac manipulation. We recommend the use of this procedure in off-pump coronary artery bypass when cardiac tilting is required.

Key Words: Coronary Artery Bypass • Off-Pump • Hemodynamics

Asian Cardiovasc Thorac Ann 2010; 18:17-21
© 2010 by SAGE Publications
DOI: 10.1177/0218492309355493


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[Abstract] [Full Text] [PDF]


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