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Article dans une revue

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

Abstract :

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.

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https://hal.univ-angers.fr/hal-03405286
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Soumis le : mercredi 27 octobre 2021 - 10:48:37
Dernière modification le : mercredi 27 octobre 2021 - 10:48:39

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Nick J. Koning, Alexander B.A. Vonk, M. Meesters, T. Oomens, M. Verkaik, et al.. Microcirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery. Cardiopulmonary Bypass and Malaria Relapse, 2014, 28 (2), pp.336 - 41. ⟨10.1053/j.jvca.2013.05.026⟩. ⟨hal-03405286⟩

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