Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion.
D'Ancona, Giuseppe Hargrove, Martin Hinchion, John Ramesh, B C Chughtai, Jehan Zeb Anjum, Muhammad Nadeem O'Donnell, Aonghus Aherne, Tom
D'Ancona, Giuseppe
Hargrove, Martin
Hinchion, John
Ramesh, B C
Chughtai, Jehan Zeb
Anjum, Muhammad Nadeem
O'Donnell, Aonghus
Aherne, Tom
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Date
2012-02-03T15:08:24Z
Date Submitted
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Subject Mesh
Cardiac Pacing, Artificial/*methods
Coronary Artery Bypass/*methods
*Coronary Circulation
Hemodynamics
Humans
Intraoperative Care/*methods
Prospective Studies
*Vascular Patency
Coronary Artery Bypass/*methods
*Coronary Circulation
Hemodynamics
Humans
Intraoperative Care/*methods
Prospective Studies
*Vascular Patency
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Principal Investigators
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Abstract
OBJECTIVE: Aim of this study was to investigate modifications of coronary grafts flow during different pacing modalities after CABG. MATERIALS AND METHODS: Two separate prospective studies were conducted in patients undergoing CABG and requiring intraoperative epicardial pacing. In a first study (22 patients) coronary grafts flows were measured during dual chamber pacing (DDD) and during ventricular pacing (VVI). In a second study (10 patients) flows were measured during DDD pacing at different atrio-ventricular (A-V) delay periods. A-V delay was adjusted in 25 ms increments from 25 to 250 ms and flow measurements were performed for each A-V delay increment. A transit time flowmeter was used for the measurements. RESULTS: An average of 3.4 grafts/patient were performed. In the first study, average coronary graft flow was 47.4+/-20.8 ml/min during DDD pacing and 41.8+/-18.2 ml/min during VVI pacing (P = 0.0004). Furthermore average systolic pressure was 94.3+/-10.1 mmHg during DDD pacing and 89.6+/-12.2 mmHg during VVV pacing (P = 0.0007). No significant differences in diastolic pressure were recorded during the two different pacing modalities. In the second study, maximal flows were achieved during DDD pacing with an A-V delay of 175 ms (54+/-9.6 ml/min) and minimal flows were detected at 25 ms A-V delay (38.1+/-4.7 ml/min) (P=ns). No significant differences in systolic or diastolic blood pressure were noticed during the different A-V delays. CONCLUSION: Grafts flowmetry provides an extra tool to direct supportive measures such as cardiac pacing after CABG. DDD mode with A-V delay around 175 ms. should be preferred to allow for maximal myocardial perfusion via the grafts.
Language
eng
ISSN
1010-7940 (Print)
1010-7940 (Linking)
1010-7940 (Linking)
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ISBN
DOI
10.1016/j.ejcts.2004.03.042
PMID
15200984