TITLE:
Cardiovascular Function during First 24 Hours after Off-Pump and On-Pump CABG—A Prospective Observational Comparative Study
AUTHORS:
Sayar Kumar Munshi, Ashis Halder, Pares Bandyopadhyay
KEYWORDS:
Off-Pump CABG, On-Pump CABG, Cardiac Index, Stroke Volume, Left Ventricular Stroke Work Index, Systemic Vascular Resistance Index
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.4,
April
13,
2023
ABSTRACT: Purpose: Myocardial revascularization by coronary
artery bypass grafting (CABG) in ischemic heart disease patients has direct
impact on hemodynamic parameters in the immediate post-operative period. The
peri-operative cardiovascular functioning is an important determinant for
outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a
negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB
but complete revascularization with difficult positioning of heart is
technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative
period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from
January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31
patients were operated for ONCAB. For the comparison, hemodynamic parameters
were measured during anesthesia before surgery, postoperatively after 1 and 4
hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters
like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left
Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are
more predominant in OPCAB group than ONCAB group although the difference is
eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall
of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after
OPCAB than ONCAB may be important for better hemodynamic stability. The
difference is however eliminated after 24 hours indicating little significance
in long term outcome.