Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time† S.E. Pischke, S. Hyler, C. Tronstad, J.

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Myocardial tissue CO2 tension detects coronary blood flow reduction after coronary artery bypass in real-time† S.E. Pischke, S. Hyler, C. Tronstad, J. Bergsland, E. Fosse, P.S. Halvorsen, H. Skulstad, T.I. Tønnessen British Journal of Anaesthesia Volume 114, Issue 3, Pages 414-422 (March 2015) DOI: 10.1093/bja/aeu381 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 Blood flow in the LIMA graft was reliably reduced from baseline levels (100%) to 75, 50 and 25% (lowest panel). Myocardial P t C O 2 increased significantly (*) and flow-dependently during all blood flow reduction events. Maximum P t C O 2 during 25% blood flow was significantly different from the two other occlusion intervals (#). Myocardial pH was significantly reduced during every blood flow reduction event (‡) and was significantly more reduced during 25% blood flow when compared with 50 and 75% blood flow (#). Myocardial P t O 2 decreased significantly during every blood flow reduction (†) and reached zero during 50 and 25% blood flow. All values expressed as median (pink lines) and quartile range (blue area); P≤0.05, exact values presented in text. British Journal of Anaesthesia 2015 114, 414-422DOI: (10.1093/bja/aeu381) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 (a) Myocardial tissue microdialysis showed significant and flow-dependent increase of lactate in the LIMA graft-dependent region (blue bars) in comparison with baseline (*) and to the Cx-dependent control area (green bars, #) when LIMA graft blood flow was reduced. (b) Tissue glucose was region specific reduced during every LIMA graft blood flow reduction with significance during 50 and 25%. (c) Myocardial glycerol increased significantly and flow-dependently in the LIMA graft-dependent region only. All values presented as mean (sd); *, #: P≤0.05, exact values presented in text. British Journal of Anaesthesia 2015 114, 414-422DOI: (10.1093/bja/aeu381) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 Regional cardiac function assessed as radial strain showed significant and flow-dependent decrease in the LIMA graft-dependent region (blue bars) in comparison with baseline (*) and to the Cx-dependent control area (green bars, #) when LIMA graft blood flow was reduced. All values presented as mean (sd); *, #: P≤0.05, exact values presented in text. British Journal of Anaesthesia 2015 114, 414-422DOI: (10.1093/bja/aeu381) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 Pearson correlation revealed significant correlation in the LIMA graft-dependent region between myocardial P t C O 2 and regional cardiac function measured as radial strain (a), tissue lactate (b), and tissue pH (c). Single values displayed as baseline (squares), LIMA blood flow 75% (open triangles), 50% (filled triangles), and 25% (diamonds). British Journal of Anaesthesia 2015 114, 414-422DOI: (10.1093/bja/aeu381) Copyright © 2015 The Author(s) Terms and Conditions

Fig 5 P t C O 2 measured by a total of 10 conductometric IscAlert sensors was obtained in 3 animals. During intervals of LIMA graft blood flow reduction, P t C O 2 increased flow-dependently in the LIMA graft-dependent region (blue), while it was unaffected in the Cx control region (green). All values expressed as median (continuous lines) and quartile range (dashed line). British Journal of Anaesthesia 2015 114, 414-422DOI: (10.1093/bja/aeu381) Copyright © 2015 The Author(s) Terms and Conditions