ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Hakkı Kazaz, Haşim Üstünsoy, Adnan Celkan, *Hasan Koçoğlu, Rengin Hayta
Gaziantep Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Ana Bilim Dalı, Gaziantep
*Gaziantep Üniversitesi Tıp Fakültesi, Anestezi ve Reanimasyon Ana Bilim Dalı, Gaziantep
Background: During off-pump surgery hemodynamic monitoring is very important but it has not been standardized. Determination of aortic blood flow using esophageal Doppler has been proposed as a low invasive hemodynamic monitoring method. We aimed to investigate the hemodynamic changes during off-pump coronary bypass with esophageal Doppler.

Methods: Thirty patients who were multivessel completly revascularized with off-pump coronary artery bypass technique by using the octopus III stabilizator and Starfish heart positioner (Medtronic Minneapolis MN) were received in the study. The esophageal echo –doppler system was used for monitorization of the hemodynamic parameters; cardiac output (CO), aortic blood flow (ABF), total systemic vascular resistance (TSVR), peak velocity (PV), stroke volume (SV), acceleration (Acc), left ventricular ejection time (LVET), heart rate, mean arterial blood pressure and aortic diameter.

Results: After clamping the left arterior descending artery (LAD) with bulldog clamp for anastomosis there was a significant decrease at the CO (Z = -2.584 p = 0.01). After reperfusing the LAD, CO increased the basic value in 2 minutes (Z = -0.773 p = 0.438) During PDA and Cx anastomosis there were no significant CO decreasing. After reperfusing all coronary arteries there was a significant increase (Z = 2.121 p = 0.034).

Conclusions: During the off-pump surgery the most important point is whether the heart tolaretes the heart position during off-pump surgery or not. Also monitorization technique has not been well accepted. The esophageal echo doppler offers accuracy equal that of the right heart catheter but in a noninvasive way.

Keywords : Off-pump, hemodynamic monitorization, coronary artery surgery, transesophaged echocardiography, complete revascularization
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