Effect of Different Operative Techniques for Myocardial Revascularisation on Hemodynamics and Myocardial Perfusion in a Porcine Model

B. Bierbach; W. Kasper-König; T. Haist; M. Meier; H. Pritzer; U. Hanenkamp; G. Horstick; O. Kempski; H. Oelert

doi:10.1055/s-2004-830442

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2005; 53(2): 103-109
DOI: 10.1055/s-2004-830442

Original Cardiovascular

Effect of Different Operative Techniques for Myocardial Revascularisation on Hemodynamics and Myocardial Perfusion in a Porcine Model[*]

B. Bierbach¹ , W. Kasper-König¹ , T. Haist¹ , M. Meier² , H. Pritzer² , U. Hanenkamp² , G. Horstick³ , O. Kempski² , H. Oelert¹

¹Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsklinik Mainz, Mainz, Germany
²Institut für Neurochirurgische Pathophysiologie, Universitätsklinik Mainz, Mainz, Germany
³II. Medizinische Klinik und Poliklinik, Universitätsklinik Mainz, Mainz, Germany

Abstract

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Abstract

Background: During surgical coronary revascularisation hemodynamics and myocardial contractility can be affected. This in vivo study aimed to determine the effects of different operative techniques on hemodynamics and regional myocardial perfusion. Methods: In 24 pigs IMA to LAD bypass was constructed using ECC (n = 8) and cardioplegic arrest, OPCAB techniques (n = 8), or the Impella® elect 100 support device (n = 8). 8 animals received a sham operation. Mean arterial pressure (MAP), cardiac output (CO), and left ventricular pressure (LVP, LVdp/dt) were recorded. Regional myocardial perfusion (RMP) of both ventricles was assessed by fluorescent microspheres. Results: MAP significantly decreased during revascularisation in all groups (p < 0.05), staying below preoperative values thereafter (p < 0.05). After ECC norepinephrine was administered to maintain MAP. CO and LVdp/dt were impaired more distinctly during OPCAB than with Impella (p < 0.05) during subsequent recovery. RMP showed global reactive hyperemia during early reperfusion after ECC, remained unchanged in OPCAB, and showed low flow during and after Impella pump run (p < 0.05). Conclusions: ECC led to hemodynamic impairment with post-ischemic reactive hyperemia. OPCAB created hemodynamic depression but left RMP unchanged. Hemodynamic depression can be reduced by the Impella® pump, however regional myocardial blood flow is decreased.

Key words

Coronary artery bypass grafting - hemodynamics - regional myocardial perfusion and microaxial blood pump

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1 Presented at the 33rd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, Hamburg February 16 - 18, 2004

Dr. Benjamin Bierbach

Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg University Mainz

Langenbeckstraße 1

55131 Mainz

Germany

Phone: + 496131172935

Fax: + 49 61 31 17 36 26

Email: bier.bach@gmx.de