Changes in systolic and diastolic function during multivessel off-pump coronary bypass grafting

Objective: To measure the changes in systolic and diastolic left ventricula r function that occur during off-pump coronary artery bypass grafting (OPCA B) as a consequence of positioning the heart and interrupting coronary flow . Methods: 2-D Transoesophageal echocardiography was used to derive systoli c wall motion indices and pulsed Doppler parameters of diastolic function i ncluding the E/A ratio, PVS/ PVD ratio, and deceleration time. A continuous cardiac output thermodilution pulmonary artery catheter was used to provid e hemodynamic measures of left ventricular function. Data was obtained prio r to, during and following coronary grafting. Results: Thirty-four consecut ive anastomoses were evaluated, including eight circumflex (LCX), 17 left a nterior descending artery (LAD) and nine right coronary artery (RCA) anasta moses. Significant changes in diastolic and systolic cardiac function were identified in those patients who underwent LCX grafting. Specifically durin g LCX grafting, both wall motion score index (2.4 +/- 1.4 vs 1.5 +/- 0.63 a nd 1.9 +/- 0.91) and the E/A ratio were significantly increased (3.5 +/- 1. 4 vs 1.5 +/- 0.33 and 1.2 +/- 0.44) when compared to RCA and LAD grafting, respectively. The PVS/PVD ratio was significantly decreased during left cir cumflex grafting (0.7 +/- 0.45 vs 1.1 +/- 0.19 and 1.0 +/- 0.58) when compa red to RCA and LAD grafting, respectively. All functional parameters return ed to baseline by the end of surgery. Conclusions: Multivessel OPCAB can be achieved with mild impairment of left ventricular function that returns to baseline by the end of the procedure. Impairment of diastolic function is most marked during circumflex grafting as demonstrated by a restrictive fil ling pattern. Measures of diastolic function may be helpful in developing b etter strategies for exposure of the circumflex graft site. (C) 2001 Elsevi er Science B.V. All rights reserved.