Central and Peripheral Circulation Differ During Off-Pump Coronary Artery Bypass Grafting

Overview

Journal Rev Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 30

PMID 39077659

Authors

Lars Saemann

Alina Zubarevich

Folker Wenzel

Jasmin Soethoff

Sevil Korkmaz-Icoz

Fabio Hoorn

Matthias Karck

Andreas Simm

Gabor Szabo

Gabor Veres

Affiliations

Soon will be listed here.

Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to on-pump coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). During OPCAB, the temporary use of an intracoronary shunt and inotropic medication or catecholamines should keep the central hemodynamics constant. Nevertheless, the need for conversion to on-pump CABG often occurs unexpectedly, most likely due to circulation instability. Circulation instability can appear first in peripheral body parts; therefore, peripheral microcirculation might serve as a predictor for the upcoming conversion to on-pump CABG. We investigated the impact of coronary artery ligation and shunt insertion during OPCAB on cutaneous microcirculation (cLDP) with Laser Doppler Perfusion Technology and transcutaneous oxygen partial pressure ( ).

Methods: In a pig model of OPCAB, peripheral circulation was evaluated after cLDP (N = 17) and (N = 6) monitoring. Systolic, diastolic, and mean arterial pressure were also observed to prove the independence of perfusion measurement results from hemodynamic parameters.

Results: Ligation time during cLDP and monitoring were 101 49 s and 83 33 s, respectively. Shunt time was 11 3 min during cLDP and 13 2 min during measurement. Ligation of the left anterior descending coronary artery (LAD) reduced cLDP significantly to 88 14% ( = 0.007) and to 71 25% ( = 0.038). Inserting a temporary shunt into the LAD significantly improved cLDP ( = 0.006) and ( = 0.015) compared to ligation. cLDP was restored to 99%, and was restored to 91% of the baseline level before ligation. All hemodynamic parameters remained stable and did not change significantly during OPCAB.

Conclusions: Although hemodynamic parameters stayed constant, peripheral microcirculation was influenced markedly during OPCAB. Inserting a temporary shut into the LAD leads to a complete normalization of peripheral microcirculation, regarding evaluation by cLDP and .

References

Trumpp A, Lohr J, Wedekind D, Schmidt M, Burghardt M, Heller A . Camera-based photoplethysmography in an intraoperative setting. Biomed Eng Online. 2018; 17(1):33. PMC: 5853087. DOI: 10.1186/s12938-018-0467-7. View

Eleftheriadou I, Tentolouris A, Grigoropoulou P, Tsilingiris D, Anastasiou I, Kokkinos A . The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus. J Diabetes Complications. 2018; 33(2):165-170. DOI: 10.1016/j.jdiacomp.2018.10.008. View

Rasche S, Trumpp A, Schmidt M, Plotze K, Gatjen F, Malberg H . Remote Photoplethysmographic Assessment of the Peripheral Circulation in Critical Care Patients Recovering From Cardiac Surgery. Shock. 2018; 52(2):174-182. DOI: 10.1097/SHK.0000000000001249. View

Bridgewater B, Grayson A, Au J, Hassan R, Dihmis W, Munsch C . Improving mortality of coronary surgery over first four years of independent practice: retrospective examination of prospectively collected data from 15 surgeons. BMJ. 2004; 329(7463):421. PMC: 514200. DOI: 10.1136/bmj.38173.577697.55. View

Leahy M, de Mul F, Nilsson G, Maniewski R . Principles and practice of the laser-Doppler perfusion technique. Technol Health Care. 1999; 7(2-3):143-62. View

Yeatman M, Caputo M, Narayan P, Ghosh A, Ascione R, Ryder I . Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. Ann Thorac Surg. 2002; 73(5):1411-7. DOI: 10.1016/s0003-4975(02)03407-0. View

Salgado M, Salgado-Filho M, Reis-Brito J, Lessa M, Tibirica E . Effectiveness of laser Doppler perfusion monitoring in the assessment of microvascular function in patients undergoing on-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2014; 28(5):1211-6. DOI: 10.1053/j.jvca.2014.03.003. View

Takami Y, Tajima K, Kato W, Fujii K, Hibino M, Munakata H . Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2012; 147(1):259-63. DOI: 10.1016/j.jtcvs.2012.10.026. View

Long C, Hu X, Zhang J, Xiu R, Guan Y . Changes of microvascular vasomotion and oxygen metabolism during cooling and rewarming period of cardiopulmonary bypass. J Extra Corpor Technol. 2003; 35(1):13-6. View

10.

Gaudino M, Angelini G, Antoniades C, Bakaeen F, Benedetto U, Calafiore A . Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate. J Am Heart Assoc. 2018; 7(16):e009934. PMC: 6201399. DOI: 10.1161/JAHA.118.009934. View

11.

Veres G, Schmidt H, Hegedus P, Korkmaz-Icoz S, Radovits T, Loganathan S . Is internal thoracic artery resistant to reperfusion injury? Evaluation of the storage of free internal thoracic artery grafts. J Thorac Cardiovasc Surg. 2018; 156(4):1460-1469. DOI: 10.1016/j.jtcvs.2018.05.079. View

12.

Krispinsky L, Stark R, Parra D, Luan L, Bichell D, Pietsch J . Endothelial-Dependent Vasomotor Dysfunction in Infants After Cardiopulmonary Bypass. Pediatr Crit Care Med. 2019; 21(1):42-49. PMC: 8098768. DOI: 10.1097/PCC.0000000000002049. View

13.

Saemann L, Wenzel F . Cutaneous microcirculation during operations with a cardiopulmonary bypass. Clin Hemorheol Microcirc. 2018; 69(1-2):13-21. DOI: 10.3233/CH-189102. View