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BJA Advance Access originally published online on February 8, 2009
British Journal of Anaesthesia 2009 102(3):316-321; doi:10.1093/bja/aep005
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Relationship between echocardiographic index of ventricular filling pressure and intraoperative haemodynamic changes during off-pump coronary bypass surgery

J. K. Shim1,2, Y. S. Choi1, D. H. Chun1, S. W. Hong1, D. H. Kim1 and Y. L. Kwak1,2,*

1 Department of Anaesthesiology and Pain Medicine
2 Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, South Korea 120-752

* Corresponding author. E-mail: ylkwak{at}yuhs.ac

Background: The ratio of mitral velocity to early-diastolic velocity of the mitral annulus (E/e') is an indicator of diastolic function representing acute loading conditions of the left ventricle. We tested the efficacy of E/e' as a predictor of haemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB), when heart displacement causes loading changes.

Methods and results: Fifty patients with left ventricular (LV) ejection fraction ≥50% were divided into two groups; E/e'<8 (normal LV filling pressure, n=25) and >15 (increased LV filling pressure, n=25). Haemodynamic measurements were recorded after induction of anaesthesia, during grafting, and after sternum closure. Patients' characteristics and operative data were similar between the groups. Cardiac index and mixed venous oxygen saturation were significantly lower during grafting and after sternum closure in the E/e'>15 group, compared with E/e'<8 group and with the baseline values. The E/e'>15 group required significantly longer ventilation time and length of stay in the intensive care unit.

Conclusions: Even in patients with preserved systolic LV function, patients with E/e'>15 were more prone to undergo a significant decrease in cardiac output during OPCAB, which did not return to baseline level after completion of grafting. Whether this finding is associated with increased morbidity and mortality should be validated.

Keywords: anaesthesia, cardiovascular; heart, myocardial function; measurement technique, Doppler echocardiography; surgery, off-pump coronary artery bypass


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
M. Edsell, J. K. Shim, Y. S. Choi, and Y. L. Kwak
Diastolic dysfunction and off-pump coronary artery bypass
Br. J. Anaesth., June 1, 2009; 102(6): 887 - 888.
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Diastolic dysfunction and OPCAB
Mark E Edsell
British Journal of Anaesthesia, 1 Apr 2009 [Full text]
Relationship between echocardiographic index of ventricular filling pressure and intraoperative haem
Young Lan Kwak, et al.
British Journal of Anaesthesia, 7 Apr 2009 [Full text]

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