Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors
Background: Emergent conversion to an on‐pump procedure during an off‐pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mecha...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2011-08, Vol.55 (7), p.870-877 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | OH, S. Y. SHIM, J. K. SONG, J. W. KIM, J. C. YOU, K. J. KWAK, Y. L. |
| description | Background: Emergent conversion to an on‐pump procedure during an off‐pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.
Methods: Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO2) |
| doi_str_mv | 10.1111/j.1399-6576.2011.02472.x |
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Methods: Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO2) <60% during grafting. Pre‐operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.
Results: In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO2 after sternum closure and a higher incidence of composite morbidity end points.
Conclusion: COPD and pre‐operative creatinine level were identified as independent risk factors of mechanical heart displacement‐induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO2 even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO2 before or during grafting.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/j.1399-6576.2011.02472.x</identifier><identifier>PMID: 21658018</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Anesthesia ; Anesthesia, General ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiac Surgical Procedures - methods ; Coronary Artery Bypass, Off-Pump ; Creatinine - blood ; Diuretics - adverse effects ; Endpoint Determination ; Female ; Heart - physiology ; Hemodynamics - physiology ; Humans ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Monitoring, Intraoperative ; Oxygen - blood ; Postoperative Complications - epidemiology ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>Acta anaesthesiologica Scandinavica, 2011-08, Vol.55 (7), p.870-877</ispartof><rights>2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation</rights><rights>2015 INIST-CNRS</rights><rights>2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4532-85553df5f497a3cd2be20ae17e6802555b05aea4eb629dd2491aec6d07dec51b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-6576.2011.02472.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-6576.2011.02472.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24320798$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21658018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OH, S. Y.</creatorcontrib><creatorcontrib>SHIM, J. K.</creatorcontrib><creatorcontrib>SONG, J. W.</creatorcontrib><creatorcontrib>KIM, J. C.</creatorcontrib><creatorcontrib>YOU, K. J.</creatorcontrib><creatorcontrib>KWAK, Y. L.</creatorcontrib><title>Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background: Emergent conversion to an on‐pump procedure during an off‐pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.
Methods: Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO2) <60% during grafting. Pre‐operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.
Results: In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO2 after sternum closure and a higher incidence of composite morbidity end points.
Conclusion: COPD and pre‐operative creatinine level were identified as independent risk factors of mechanical heart displacement‐induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO2 even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO2 before or during grafting.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Coronary Artery Bypass, Off-Pump</subject><subject>Creatinine - blood</subject><subject>Diuretics - adverse effects</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Heart - physiology</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative</subject><subject>Oxygen - blood</subject><subject>Postoperative Complications - epidemiology</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU2P0zAQhi0EYrsLfwH5gjgl-COOkwOHqlp2QRUcFsTRmtiTxSVf2Ak0_56EljKXmdH7vCPZLyGUs5Qv9faQclmWSa50ngrGecpEpkV6fEI2F-Ep2TDGeKK4FlfkOsbDssqsLJ-TK8FzVTBebMivHQTnwVLn49CAxRa7MfGdmyw6-h3b3s0dtN5S38URKt_4caZuCr57pH1dJ8PUDtT2oe8gzBTCiEur5gFipHEKj-sKnaN-jHQI6Lwd-xBfkGc1NBFfnvsN-fr-9svuPtl_vvuw2-4TmykpkkIpJV2t6qzUIK0TFQoGyDXmBROLWDEFCBlWuSidE1nJAW3umHZoFa_kDXlzujuE_ueEcTStjxabBjrsp2gKnetCKiYW8tWZnKoWnRmCb5cXmX9ftQCvzwBEC00doLM-_ucyKZguV-7difvtG5wvOmdmjc4czJqQWRMya3Tmb3TmaLbbh3Va_MnJ7-OIx4sfwg-Ta6mV-fbpznws9oUquDQP8g_Amp3u</recordid><startdate>201108</startdate><enddate>201108</enddate><creator>OH, S. Y.</creator><creator>SHIM, J. K.</creator><creator>SONG, J. W.</creator><creator>KIM, J. C.</creator><creator>YOU, K. J.</creator><creator>KWAK, Y. L.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201108</creationdate><title>Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors</title><author>OH, S. Y. ; SHIM, J. K. ; SONG, J. W. ; KIM, J. C. ; YOU, K. J. ; KWAK, Y. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4532-85553df5f497a3cd2be20ae17e6802555b05aea4eb629dd2491aec6d07dec51b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia, General</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Coronary Artery Bypass, Off-Pump</topic><topic>Creatinine - blood</topic><topic>Diuretics - adverse effects</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Heart - physiology</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative</topic><topic>Oxygen - blood</topic><topic>Postoperative Complications - epidemiology</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>OH, S. Y.</creatorcontrib><creatorcontrib>SHIM, J. K.</creatorcontrib><creatorcontrib>SONG, J. W.</creatorcontrib><creatorcontrib>KIM, J. C.</creatorcontrib><creatorcontrib>YOU, K. J.</creatorcontrib><creatorcontrib>KWAK, Y. L.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>OH, S. Y.</au><au>SHIM, J. K.</au><au>SONG, J. W.</au><au>KIM, J. C.</au><au>YOU, K. J.</au><au>KWAK, Y. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2011-08</date><risdate>2011</risdate><volume>55</volume><issue>7</issue><spage>870</spage><epage>877</epage><pages>870-877</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background: Emergent conversion to an on‐pump procedure during an off‐pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.
Methods: Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO2) <60% during grafting. Pre‐operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.
Results: In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO2 after sternum closure and a higher incidence of composite morbidity end points.
Conclusion: COPD and pre‐operative creatinine level were identified as independent risk factors of mechanical heart displacement‐induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO2 even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO2 before or during grafting.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21658018</pmid><doi>10.1111/j.1399-6576.2011.02472.x</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Anesthesia Anesthesia, General Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiac Surgical Procedures - methods Coronary Artery Bypass, Off-Pump Creatinine - blood Diuretics - adverse effects Endpoint Determination Female Heart - physiology Hemodynamics - physiology Humans Logistic Models Male Medical sciences Middle Aged Monitoring, Intraoperative Oxygen - blood Postoperative Complications - epidemiology Predictive Value of Tests Retrospective Studies Risk Factors Treatment Outcome |
| title | Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors |
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