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    Coronary grafts flow and cardiac pacing modalities: how to improve perioperative myocardial perfusion.

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    Authors
    D'Ancona, Giuseppe
    Hargrove, Martin
    Hinchion, John
    Ramesh, B C
    Chughtai, Jehan Zeb
    Anjum, Muhammad Nadeem
    O'Donnell, Aonghus
    Aherne, Tom
    Affiliation
    Department of Cardiac Surgery, Cork University Hospital, Cork, Ireland., rgea@hotmail.com
    Issue Date
    2012-02-03T15:08:24Z
    MeSH
    Cardiac Pacing, Artificial/*methods
    Coronary Artery Bypass/*methods
    *Coronary Circulation
    Hemodynamics
    Humans
    Intraoperative Care/*methods
    Prospective Studies
    *Vascular Patency
    
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    Citation
    Eur J Cardiothorac Surg. 2004 Jul;26(1):85-8.
    Journal
    European journal of cardio-thoracic surgery : official journal of the European, Association for Cardio-thoracic Surgery
    URI
    http://hdl.handle.net/10147/208955
    DOI
    10.1016/j.ejcts.2004.03.042
    PubMed ID
    15200984
    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)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejcts.2004.03.042
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    Cork University Hospital

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