Microcirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery

TitreMicrocirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery
Type de publicationArticle de revue
AuteurKoning, Nick J., Vonk, Alexander B.A., Meesters, M. I, Oomens, T., Verkaik, M., Jansen, E. K, Baufreton, Christophe , Boer, Christa
EditeurWB Saunders
TypeArticle scientifique dans une revue à comité de lecture
Pagination336 - 41
Titre de la revueJournal of Cardiothoracic and Vascular Anesthesia
Résumé en anglais

OBJECTIVE: This study investigated the perioperative course of microcirculatory perfusion in off-pump compared with on-pump surgery. Additionally, the impact of changes in systemic hemodynamics, hematocrit, and body temperature was studied. DESIGN: Prospective, nonrandomized, observational study. SETTING: Tertiary university hospital. PARTICIPANTS: Patients undergoing coronary artery bypass grafting with (n = 13) or without (n = 13) use of cardiopulmonary bypass. INTERVENTIONS: Microcirculatory measurements were obtained at 5 time points ranging from induction of anesthesia to ICU admission. MEASUREMENTS AND MAIN RESULTS: Microcirculatory recordings were performed with sublingual sidestream dark field imaging. Despite a comparable reduction in intraoperative blood pressure between groups, the perfused vessel density decreased more than 20% after onset of extracorporeal circulation but remained stable in the off-pump group. The reduction in microvascular perfusion in the on-pump group was further paralleled by decreased hematocrit and temperature. Although postbypass hematocrit levels and body temperature were restored to similar levels as in the off-pump group, the median microvascular flow index remained reduced after bypass (2.4 [2.3-2.7]) compared with baseline (2.8 [2.7-2.9]; p = 0.021). CONCLUSIONS: Microcirculatory perfusion remained unaltered throughout off-pump surgery. In contrast, microvascular perfusion declined after initiation of cardiopulmonary bypass and did not recover in the early postoperative phase.

URL de la noticehttp://okina.univ-angers.fr/publications/ua8315
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Titre abrégéJ Cardiothorac Vasc Anesth