Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Central hemodynamics in coronary artery revascularization operations without cardiopulmonary bypass

Authors: Khinchagov D.Ya., Rybka M.M.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-3-201-211

UDC: 616.127-089.168:616.12-005.4-052

Link: Clinical Physiology of Blood Circulaiton. 2021; 3 (18): 201-211

Quote as: Khinchagov D.Ya., Rybka M.M. Central hemodynamics in coronary artery revascularization operations without cardiopulmonary bypass. Clinical Physiology of Circulation. 2021; 18 (3): 201–11 (in Russ.). DOI: 10.24022/1814-6910-2021-18-3-201-211

Received / Accepted:  03.09.2021 / 21.09.2021

Full text:  

Abstract

In off-pump coronary artery bypass (OPCAB) for the implementation of complete revascularization of the affected coronary arteries without connecting the cardiopulmonary bypass, the anesthetic risk increases and the degree of difficulty in providing anesthesia increases. OPCAB impose new requirements for anesthetic management, which is associated with impaired myocardial function and hemodynamic disorders due to cardiac positioning and coronary artery clamping, which necessitates careful monitoring, adequate inotropic support and infusion therapy. This article highlights the current understanding of central hemodynamics during the main stage and recommendations for performing complete myocardial revascularization, reducing the risk of conversion to cardiopulmonary bypass. An overview of the main scientific works in the field of anesthetic management and stable hemodynamics during OPCAB is given.

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****
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  10. Moutlana H.J. Off pump coronary artery bypass graft. South. Afr. J. Anaesth. Analg. 2018; 24 (3): 86–9.
  11. Ammannaya G.K.K., Basantwani S., Mishra P., Khandekar J.V. Effect of octopus tissue stabilizer on cardiac output during off-pump coronary artery bypass graft surgery. Kardiochir. Torakochir. Pol. 2019; 16 (2): 69–73. DOI: 10.5114/kitp.2019.86358
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  13. Do Q.B., Goyer C., Chavanon O., Couture P., Denault A., Cartier R. Hemodynamic changes during offpump CABG surgery. Eur. J. Cardiothorac. Surg. 2002; 21: 385–90. DOI: 10.1016/s1010-7940(02)00009-x
  14. Porat E., Sharony R., Ivry S., Ozaki S., Meyns B.P., Flameng W.J. et al. Hemodynamic changes and right heart support during vertical displacement of the beating heart. Ann. Thorac. Surg. 2000; 69: 1188–91. DOI: 10.1016/s0003-4975(99)01437-x
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  21. Hemmerling T.M., Romano G., Terrasini N., Noiseux N. Anesthesia for off-pump coronary artery bypass surgery. Ann. Cardiac. Anaesth. 2013; 16: 28–39. DOI: 10.4103/0971-9784.105367
  22. Zangrillo A., Pappalardo F., Dossi R., Di Prima A.L., Sassone M.E., Greco T. et al. Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Crit. Care. 2015; 19 (1): 10. DOI: 10.1186/s13054-014-0728-1
  23. Suzuki T., Okabe M., Handa M., Yasuda F., Miyake Y. Usefulness of preoperative intraaortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients. Ann. Thorac. Surg. 2004; 77: 2056–9. DOI: 10.1016/j.athoracsur.2003.12.027
  24. Yoon S.S., Bang J.H., Jeong S.S., Jeong J. H., Woo J.S. et al. Risk factors of on-pump conversion during offpump coronary artery bypass graft. Korean J. Thorac. Cardiovasc. Surg. 2017; 50: 355–62. DOI: 10.5090/kjtcs.2017.50.5.355
  25. Patel N.C., Patel N.U., Loulmet D.F., McCabe J.C., Subramanian V.A. Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality. J. Thorac. Cardiovasc. Surg. 2004; 128: 655–61. DOI: 10.1016/j.jtcvs.2004.04.043
  26. Vassiliades T.A. Jr, Nielsen J.L., Lonquist J.L. Hemodynamic collapse during off-pump coronary artery bypass grafting. Ann. Thorac. Surg. 2002; 73: 1874–9. DOI: 10.1016/s0003-4975(02)03592-0
  27. Chakravarthy M.R., Prabhakumar D. Anaesthesia for off pump coronary artery bypass grafting – the current concepts. Indian J. Anaesth. 2007; 51 (4): 334–43.
  28. Michelsen L.G., Horswell J. Anesthesia for off-pump coronary artery bypass grafting. Semin. Thorac. Cardiovasc. Surg. 2003; 15: 71–82. DOI: 10.1016/S1043-0679(03)70044-6
  29. Lee E.H., Lee H.M., Chung C.H., Chin J.H., Choi D.K., Chung H.J. et al. Impact of intravenous lidocaine on myocardial injury after off-pump coronary artery surgery. Br. J. Anaesth. 2011; 106: 487–93. DOI: 10.1093/bja/aeq416
  30. Hett D.A. Anaesthesia for off-pump coronary artery surgery. CEACCP. 2006; 6 (2): 60–2. DOI: 10.1093/bjaceaccp/mkl005
  31. Maslow A.D., Regan M.M., Heindle S., Panzica P., Cohn W.E., Johnson R.G. Postoperative atrial tachyarrhythmias in patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass: a role for intraoperative magnesium supplementation. J. Cardiothorac. Vasc. Anesth. 2000; 14: 524–30. DOI: 10.1053/jcan.2000.9485
  32. Zangrillo A., Landoni G., Sparicio D., Pappalardo F., Bove T., Cerchierini E. et al. Perioperative magnesium supplementation to prevent atrial fibrillation after offpump coronary artery surgery: a randomized controlled study. J. Cardiothorac. Vasc. Anesth. 2005; 19: 723–8. DOI: 10.1053/j.jvca.2005.02.015
  33. Tempe D., Virmani S. Anaesthesia for off-pump coronary artery surgery. Ann. Card. Anaesth. 2007; 10 (1): 65–71. DOI: 10.4103/0971-9784.37931
  34. Fellahi J.L., Godier A., Benchetrit D., Berthier F., Besch G., Bochaton T. et al. Perioperative management of patients with coronary artery disease undergoing non-cardiac surgery: summary from the French Society of Anaesthesia and Intensive Care Medicine 2017 convention. Anaesth. Crit. Care Pain Med. 2018; 37 (4): 367–74. DOI: 10.1016/j.accpm.2018.02.021
  35. Dryden L., Maccario M. Anaesthesia for off-pump coronary artery bypass grafting. Anaesth. Intensive Care Med. 2018; 19: 281–4. DOI: 10.1016/j.mpaic.2018.03.009
  36. Öztürk B.M., Karadeniz Ü., Gökbulut Bekta 5 s S., 5 Demir A., Çaˇgll K., Erdemli Ö. Fast-track anaesthesia in off-pump coronary surgery: a comparison of normotensive and hypertensive patients. Turk. J. Anaesth. Reanim. 2018; 46: 276–82. DOI: 10.5152/TJAR. 2018.70493
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About Authors

  • Dzhumber Ya. Khinchagov, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology and Resuscitation; ORCID

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