Haemodynamic changes during beating heart coronary surgery with the 'Bristol Technique'

Objectives: Optimal exposure and stabilization of the target coronary vesse l is essential to allow the construction of a precise coronary anastomosis during off pump coronary surgery. However, this might be achieved at the ex pense of significant haemodynamic deterioration, particularly while graftin g the circumflex and the posterior descending coronary arteries. The presen t study was designed to assess the haemodynamic changes with the beating he art positioned for grafting the three main coronaries. Methods: Twenty-nine consecutive patients (21 male, mean age 62.6 +/- 7.1 years) undergoing off pump coronary surgery were enrolled in the study. Three different surgical settings of exposure and stabilization were used according to the site of anastomosis: left anterior descending (LAD - set-up 1; n = 29), posterior d escending (PDA - set-up 2; n = 15), and circumflex (Cx - set-up 3; n = 21) coronary arteries. Haemodynamic measurements were recorded before any cardi ac manipulation (baseline) in set-ups 1, 2 and 3, and immediately after the completion of each distal anastomosis with the heart returned to its anato mical position. Results: There were no marked changes in heart rate (HR) an d systemic mean arterial pressure during the construction of the anastomose s for any of the three surgical settings. Set-up 1 (LAD) showed a decrease of 15.5% in stroke volume (SV) and an increase of 9% in pulmonary capillary wedge pressure (PCWP) compared to baseline (both P < 0.05), with all the o ther haemodynamic parameters remaining unchanged. Set-up 2 (PDA) showed a m arked decrease in SV and cardiac index (CI), and an increase in central ven ous pressure (CVP) when compared to baseline (all P < 0.05). The most exten sive changes were observed in set-up 3 (Cx) with a considerable reduction i n SV and CI, and an increase in CVP, PCWP, pulmonary arterial pressure, and systemic vascular resistance index (all P < 0.05). These haemodynamic chan ges were transient and totally recovered after the heart was returned to it s anatomical position. Conclusions: Exposure and stabilization of the three main coronary arteries during beating heart surgery does not produce any a ppreciable change in systemic blood pressure and HR. The haemodynamic deter ioration observed during the construction of the circumflex and posterior d escending coronary arteries distal anastomoses is transient and well tolera ted with no adverse clinical events. (C) 2001 Elsevier Science B.V. All rig hts reserved.