Changes in systolic and diastolic function during multivessel off-pump coronary bypass grafting

Objective: To measure the changes in systolic and diastolic left ventricular function that occur during off-pump coronary artery bypass grafting (OPCAB) as a consequence of positioning the heart and interrupting coronary flow. Methods: 2-D Transoesophageal echocardiography was used to derive systolic wall motion indices and pulsed Doppler parameters of diastolic function including the E/A ratio, PVS/PVD ratio, and deceleration time. A continuous cardiac output thermodilution pulmonary artery catheter was used to provide hemodynamic measures of left ventricular function. Data was obtained prior to, during and following coronary grafting. Results: Thirty-four consecutive anastomoses were evaluated, including eight circumflex (LCX), 17 left anterior descending artery (LAD) and nine right coronary artery (RCA) anastamoses. Significant changes in diastolic and systolic cardiac function were identified in those patients who underwent LCX grafting. Specifically during LCX grafting, both wall motion score index (2.4 ± 1.4 vs 1.5 ± 0.63 and 1.9 ± 0.91) and the E/A ratio were significantly increased (3.5 ± 1.4 vs 1.1 ± 0.33 and 1.2 ± 0.44) when compared to RCA and LAD grafting, respectively. The PVS/PVD ratio was significantly decreased during left circumflex grafting (0.7 ± 0.45 vs 1.1 ± 0.19 and 1.0 ± 0.58) when compared to RCA and LAD grafting, respectively. All functional parameters returned to baseline by the end of surgery. Conclusions: Multivessel OPCAB can be achieved with mild impairment of left ventricular function that returns to baseline by the end of the procedure. Impairment of diastolic function is most marked during circumflex grafting as demonstrated by a restrictive filling pattern. Measures of diastolic function may be helpful in developing better strategies for exposure of the circumflex graft site.