Analysis of hemodynamic changes during beating heart surgical procedures
Analysis of hemodynamic changes during beating heart surgical procedures
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DOI：
10.1016/s0003-4975(00)01590-3
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发表时间：
2000-10-01
影响因子：
4.6
通讯作者：
Mack, MJ
中科院分区：
文献类型：
--
作者：
Mathison, M;Edgerton, JR;Mack, MJ
背景资料。心脏不停跳时的冠状动脉旁路移植术会在心脏移位期间造成显著的血流动力学损害。引起血流动力学改变的确切机制尚不清楚。本研究的目的是明确心脏不停跳手术中心脏移位引起的血流动力学变化。44例患者(男性35例，女性9例；平均年龄64.5±9.6岁)接受了非体外循环冠状动脉旁路移植术。测量冠状动脉左前降支、回旋支和后降支吻合前后的血流动力学参数。所有血管定位时右室舒张末压显著升高，左冠状动脉前降支和回旋支定位时左室舒张末压显著升高。旋支动脉定位显示左、右室舒张末压力增加最大，血流动力学损害最大。在患病的人类心脏的临床环境中，血液动力学的改变与双侧脑室有关。各体位右室舒张期末压均升高，提示血流动力学改变的主要原因是右室舒张期充盈紊乱，尤其是直接的室壁压缩。(C)2000年由胸外科医生学会主办。
Background. Coronary artery bypass grafting on the beating heart causes significant hemodynamic compromise during displacement of the heart. The precise mechanisms causing altered hemodynamics have not been clearly understood. The purpose of this study was to define the hemodynamic changes caused by displacing the heart in patients undergoing beating heart surgical procedures.Methods. Forty-four patients (35 men, 9 women; mean age, 64.5 +/- 9.6 years) underwent off-pump coronary artery bypass grafting. The hemodynamic variables were collected before and after positioning the heart for anastomosis of the left anterior descending, circumflex, and posterior descending coronary arteries.Results. There was a significant increase in right ventricular end-diastolic pressure during positioning for all vessels, and in left ventricular end-diastolic pressure during positioning for the left anterior descending and circumflex coronary arteries. Positioning for the circumflex artery showed the largest increase of left and right ventricular end-diastolic pressure, resulting in the greatest hemodynamic compromise.Conclusions. In the clinical setting of diseased human hearts, there is a biventricular contribution to altered hemodynamics. The increase of right ventricular end-diastolic pressure in all positions suggests that the major cause of hemodynamic changes is disturbed diastolic filling of the right ventricle, especially by direct ventricular compression. (C) 2000 by The Society of Thoracic Surgeons.