Abstract

Introduction: The potential benifits of off pump CABG (OPCABG) include not only reduced systemic inflammation, coagulopathy, atheroembolism, brain edema, respiratory and other end-organ dysfunction but also more cost-effective resource utilization. However, during OPCABG there is inevitable hemodynamic instability during manual positioning of heart & mechanical stabilisation.

Materials & Methods: Over a period of one year, 50 patients undergoing OPCABG, were monitored for significant changes in Central Venous Pressure (CVP), Mean Arterial Pressure (MAP), Mean Pulmonary Arterial Pressure (MPAP) & Left Ventricular End Diastolic Pressure (LVEDP) during operation  at baseline, during manipulation & shunt introduction, during anastomosis & after anastomosis.

Results: MAP significantly reduced compared to baseline value (76±11.6) during manipulation & shunt introduction in the diagonals (70±5.6; p<0.045), ramus (70±5.0; p<0.043), obtuse marginals (65±5.5; p<0.029) & the right sided arteries ie. PDA/RCA/PLV (69±5.0; p<0.038). We also found that while grafting the ramus & the OMs, there was significant rise in CVP during positioning of heart & shunt introduction. Interestingly, while doing the same manouver,  significant rise in MPAP was witnessed only for the OMs and none others.

Conclusion: Judicious handling of heart during positioning & mechanical stabilization for grafting can minimize the inevitable haemodynamic changes that occur during OPCABG. Monitoring the haemodynamic parameters continuously help us in modifying our mechanical & anaesthetic adjustment strategies preventing unnecessary use of cardio pulmonary bypass.