Analysis of hemodynamic changes during beating heart surgical procedures

Background. Coronary artery bypass grafting on the beating heart causes sig nificant hemodynamic compromise during displacement of the heart. The preci se mechanisms causing altered hemodynamics have not been clearly understood . The purpose of this study was to define the hemodynamic changes caused by displacing the heart in patients undergoing beating heart surgical procedu res. Methods. Forty-four patients (35 men, 9 women; mean age, 64.5 +/- 9.6 years ) underwent off-pump coronary artery bypass grafting. The hemodynamic varia bles were collected before and after positioning the heart for anastomosis of the left anterior descending, circumflex, and posterior descending coron ary arteries. Results. There was a significant increase in right ventricular end-diastoli c pressure during positioning for all vessels, and in left ventricular end- diastolic pressure during positioning for the left anterior descending and circumflex coronary arteries. Positioning for the circumflex artery showed the largest increase of left and right ventricular end-diastolic pressure, resulting in the greatest hemodynamic compromise. Conclusions. In the clinical setting of diseased human hearts, there is a b iventricular contribution to altered hemodynamics. The increase of right ve ntricular end-diastolic pressure in all positions suggests that the major c ause of hemodynamic changes is disturbed diastolic filling of the right ven tricle, especially by direct ventricular compression. (C) 2000 by The Socie ty of Thoracic Surgeons.