Cardiac displacement during off-pump coronary artery bypass grafting surgery: effect on sublingual microcirculation and cerebral oxygenation

Bektas Atasever, Christa Boer, Ron Speekenbrink, Jan Seyffert, Peter Goedhart, Bas de Mol, Can Ince

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Abstract

Cardiac displacement during off-pump coronary artery bypass (OPCAB) surgery causes a fall in cardiac output. Here, we investigate how this drop in systemic perfusion is transferred to the oxygenation of sublingual and cerebral tissue. Sublingual microcirculatory perfusion or microcirculatory hemoglobin oxygen saturation (mu HbSO(2)) measurements were performed using sidestream dark-field imaging and reflectance spectrophotometry, respectively (both n=12). The cerebral tissue oxygenation index was measured by near-infrared spectrophotometry (n=12). Cardiac output was calculated by pulse contour analysis of arterial pressure. Cardiac displacement reduced the cardiac output from 4.3 +/- 0.8 to 1.2 +/- 0.3 l/min (P <0.05), paralleled by a decrease in mu HbSO(2) from 64.2 +/- 9.1 to 48.6 +/- 8.7% (P <0.01). Cardiac displacement did not change functional capillary density, while red blood cell velocity decreased from 895 +/- 209 to 396 +/- 178 mu m/s (P <0.01). Cerebral tissue oxygenation index decreased from 69.5 +/- 4.0 to 57.4 +/- 8.5% (P <0.01) during cardiac displacement. After repositioning of the heart, all the values returned to baseline. Our data suggest that systemic hemodynamic alterations during cardiac displacement in OPCAB surgery reduce sublingual and cerebral tissue oxygenation. These findings are particularly important for patients at risk for the consequences of cerebral ischemia. (c) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved
Original languageEnglish
Pages (from-to)573-577
JournalInteractive cardiovascular and thoracic surgery
Volume13
Issue number6
DOIs
Publication statusPublished - 2011

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