Off-pump coronary artery bypass surgery: physiology and anaesthetic management

Increasing interest is being shown in beating heart (off-pump) coronary artery surgery (OPCAB) because, compared with operations performed with cardiopulmonary bypass, OPCAB surgery may be associated with decreased postoperative morbidity and reduced total costs. Its appears to produce better result...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2004-03, Vol.92 (3), p.400-413
Main Authors: Chassot, P.-G., van der Linden, P, Zaugg, M, Mueller, X.M., Spahn, D.R.
Format: Article
Language:English
Subjects:
anaesthesia
anaesthesia, cardiovascular
Anesthesia
Anesthesia, General - methods
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiopulmonary Bypass - adverse effects
cardiovascular
complications
complications, intraoperative myocardial ischaemia
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - methods
heart
heart, manipulation technique
Hemodynamics
Humans
Intraoperative Care - methods
intraoperative myocardial ischaemia
manipulation technique
Medical sciences
monitoring
Myocardial Ischemia - prevention & control
off‐pump coronary artery bypass
outcome studies
surgery
surgery, off-pump coronary artery bypass
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Summary:Increasing interest is being shown in beating heart (off-pump) coronary artery surgery (OPCAB) because, compared with operations performed with cardiopulmonary bypass, OPCAB surgery may be associated with decreased postoperative morbidity and reduced total costs. Its appears to produce better results than conventional surgery in high-risk patient populations, elderly patients, and those with compromised cardiac function or coagulation disorders. Recent improvements in the technique have resulted in the possibility of multiple-vessel grafting in all coronary territories, with a graft patency comparable with conventional surgery. During beating-heart surgery, anaesthetists face two problems: first, the maintenance of haemodynamic stability during heart enucleation necessary for accessing each coronary artery; and second, the management of intraoperative myocardial ischaemia when coronary flow must be interrupted during grafting. The anaesthetic technique is less important than adequate management of these two major constraints. However, experimental and recent clinical data suggest that volatile anaesthetics have a marked cardioprotective effect against ischaemia, and might be specifically indicated. OPCAB surgery requires team work between anaesthetists and surgeons, who must be aware of each other's constraints. Some surgical aspects of the operation are reviewed along with physiological and anaesthetic data.
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aeh064