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• W1967948708 abstract "Extracorporeal circulation is no longer seen as an obligatory sacrifice for coronary artery revascularization as in the past. The advantages of off-pump coronary artery bypass graft (CABG) surgeries most commonly reported are decreased operative mortality, improved perioperative outcome, reduced perioperative myocardial infarction incidence, and shorter hospital stay.1Benetti FJ Naseli G Wood M Geffner L Direct myocardial revascularisation without extracorporeal circulation: Experience in 700 patients.Chest. 1991; 100: 312-316Crossref PubMed Scopus (541) Google Scholar, 2Pfizter AJ Zalsi MS Gargia JM et al.Coronary artery bypass without cardiopulmonary bypass.Ann Thorac Surg. 1992; 54: 1085-1092Abstract Full Text PDF PubMed Scopus (286) Google Scholar, 3Buffelo E Andrade JCS Succi J et al.Direct myocardial revascularisation without cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1985; 33: 26-29Crossref Scopus (132) Google Scholar, 4Kirklin JK Westaby S Blabatone EH et al.Complement and damaging effects of cardiopulmonary bypass.J Thorac Vasc Anesth. 1983; 86: 845-857Google Scholar, 5Nusmeir NA Neuropsychiatric complications of cardiac surgery.J Thorac Vasc Anesth. 1994; 8: 513-518Google Scholar, 6Grundeman PF Borst C Van Heerwaarden JA et al.Haemodynamic changes during displacement of the beating heart by the utrecht octopus method.Ann Thorac Surg. 1997; 63: S88-S92Abstract Full Text PDF PubMed Scopus (145) Google Scholar, 7Mohrkoritz Y Sternik L Puz Y et al.Primary coronary artery grafting without cardiopulmonary bypass in impaired left ventricular function.Ann Thorac Surg. 1997; 63: S44-S47Abstract Full Text PDF PubMed Scopus (80) Google Scholar, 8Gulielmos V Schueler S Minimal invasive cardiac surgery for the treatment of coronary artery multi disease.Eur J Cardiothorac Surg. 1998; 14: S48-S53Crossref PubMed Google Scholar, 9Mishra Y Mehta Y Kohli VM et al.Coronary artery bypass surgery without cardiopulmonary bypass: Short- and mid-term results.Indian Heart J. 1997; 49: 511-517PubMed Google Scholar Avoiding the use of cardiopulmonary bypass can prevent the severe inflammatory response and systemic release of microthrombi, which adversely affect the patient's coagulation system and cognitive performance.4Kirklin JK Westaby S Blabatone EH et al.Complement and damaging effects of cardiopulmonary bypass.J Thorac Vasc Anesth. 1983; 86: 845-857Google Scholar, 5Nusmeir NA Neuropsychiatric complications of cardiac surgery.J Thorac Vasc Anesth. 1994; 8: 513-518Google Scholar Off-pump CABG procedures are becoming popular.1Benetti FJ Naseli G Wood M Geffner L Direct myocardial revascularisation without extracorporeal circulation: Experience in 700 patients.Chest. 1991; 100: 312-316Crossref PubMed Scopus (541) Google Scholar, 2Pfizter AJ Zalsi MS Gargia JM et al.Coronary artery bypass without cardiopulmonary bypass.Ann Thorac Surg. 1992; 54: 1085-1092Abstract Full Text PDF PubMed Scopus (286) Google Scholar, 3Buffelo E Andrade JCS Succi J et al.Direct myocardial revascularisation without cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1985; 33: 26-29Crossref Scopus (132) Google Scholar, 7Mohrkoritz Y Sternik L Puz Y et al.Primary coronary artery grafting without cardiopulmonary bypass in impaired left ventricular function.Ann Thorac Surg. 1997; 63: S44-S47Abstract Full Text PDF PubMed Scopus (80) Google Scholar At our center from December 1996 to February 2000, we performed 838 off-pump procedures. Monitoring during revascularization consists of ST-segment analysis (lead II and modified chest leads on Omnicare anesthesia monitoring system, HP model 665; Hewlett Packard, Andover, MA), direct arterial blood pressure, pulmonary artery pressure and cardiac output monitoring by pulmonary artery catheter, urine output, temperature, oxygen saturation by pulse oximetry, end-tidal carbon dioxide, end-tidal isoflurane, and online transesophageal echocardiography. No major changes in hemodynamics have been seen during left anterior descending artery revascularization, but there is often a significant decrease in arterial pressures and cardiac output when circumflex and right coronary artery grafting is done. This decrease is mostly due to retraction, lifting, and compression of the heart either manually by the assistant's hand or by the mechanical stabilizer. Hypotension during this period can jeopardize the already ischemic myocardium, made worse by proximal occlusion of the target vessel. To overcome this problem, we initially infused volume (usually a crystalloid) or administered boluses of vasopressor (ephedrine, 6 mg/mL, or norepinephrine, 2 mg diluted in 250 mL of normal saline) until desirable pressures (at least 80 mmHg of systolic) were achieved. As our experience increased, we started treating more and more patients for whom cardiopulmonary bypass was contraindicated (ie, mobile atheroma, chronic renal failure, carotid artery disease).4Kirklin JK Westaby S Blabatone EH et al.Complement and damaging effects of cardiopulmonary bypass.J Thorac Vasc Anesth. 1983; 86: 845-857Google Scholar, 5Nusmeir NA Neuropsychiatric complications of cardiac surgery.J Thorac Vasc Anesth. 1994; 8: 513-518Google Scholar Because these cases required a higher perfusion pressure, we needed to start an infusion of norepinephrine (2 mg diluted in 250 mL of normal saline) instead of giving frequent boluses. This infusion kept the pressure at a uniform desired level instead of a roller coaster, the kind we were getting earlier with boluses. The arterial pressure is predominantly maintained by increasing the systemic vascular resistance, and in the process, we found the cardiac output to decrease.6Grundeman PF Borst C Van Heerwaarden JA et al.Haemodynamic changes during displacement of the beating heart by the utrecht octopus method.Ann Thorac Surg. 1997; 63: S88-S92Abstract Full Text PDF PubMed Scopus (145) Google Scholar, 7Mohrkoritz Y Sternik L Puz Y et al.Primary coronary artery grafting without cardiopulmonary bypass in impaired left ventricular function.Ann Thorac Surg. 1997; 63: S44-S47Abstract Full Text PDF PubMed Scopus (80) Google Scholar We have not found any detrimental effect of this transient decrease in cardiac output. It is suggested that a pure predominant α-agonist can be used for this purpose because it does not increase the heart rate, which can make surgery more difficult." @default.
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• W1967948708 date "2000-12-01" @default.
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• W1967948708 title "Vasopressor infusion during off-pump coronary artery bypass graft surgery" @default.
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