Comparing microvascular alterations during minimal extracorporeal circulation and conventional cardiopulmonary bypass in coronary artery bypass graft.

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Presentation transcript:

Comparing microvascular alterations during minimal extracorporeal circulation and conventional cardiopulmonary bypass in coronary artery bypass graft surgery: A prospective, randomized study Peter Donndorf, MD, Franziska Kühn, MD, Brigitte Vollmar, MD, PhD, Jan Rösner, MD, PhD, Andreas Liebold, MD, PhD, Philipp Gierer, MD, PhD, Gustav Steinhoff, MD, PhD, Alexander Kaminski, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 3, Pages 677-683 (September 2012) DOI: 10.1016/j.jtcvs.2012.05.037 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Representative images of sublingual microcirculation obtained by orthogonal polariztion spectral (OPS) imaging at 4 time points during on-pump coronary artery bypass grafting: T1, at skin incision (baseline); T2, 10 minutes after aortic crossclamping; T3, 10 minutes after release of the aortic crossclamp; T4, 30 minutes after termination of cardiopulmonary bypass (manual offline measurement of the sublingual functional capillary density by line drawing is illustrated). The Journal of Thoracic and Cardiovascular Surgery 2012 144, 677-683DOI: (10.1016/j.jtcvs.2012.05.037) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative mean arterial pressure (mm Hg) during coronary artery bypass graft surgery measured at 4 time points: T1, after skin incision (baseline); T2, 10 minutes after aortic crossclamping; T3, 10 minutes after release of the aortic crossclamp; T4, 30 minutes after termination of cardiopulmonary bypass. The line graphs illustrate the variation of the mean arterial pressure during on–pump coronary bypass grafting using minimized (MECC, n = 20 patients) or conventional (CECC, n = 20 patients) extracorporeal circulation. Asterisks denote statistically significant intergroup differences. Symbols indicate significant differences relative to baseline within each group: *P < .05, MECC versus CECC; #P < .05 versus T1 CECC (baseline); §P < .05 versus T1 MECC (baseline). Data are presented as means ± standard error of the mean. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 677-683DOI: (10.1016/j.jtcvs.2012.05.037) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Intraoperative serum lactate (mmol/L) and hematocrit (%) during coronary artery bypass graft surgery measured at 4 time points: T1, after skin incision (baseline); T2, 10 minutes after aortic crossclamping; T3, 10 minutes after release of the aortic crossclamp; T4, 30 minutes after termination of the CPB. The line graphs illustrate the variation of the serum lactate level (upper panel) and the hematocrit (lower panel) during on-pump coronary bypass grafting using minimized (MECC, n = 20 patients) or conventional (CECC, n = 20 patients) extracorporeal circulation. Asterisks denote statistically significant intergroup differences. Symbols indicate significant differences relative to baseline within each group. *P < .05 MECC versus CECC; #P < .05 versus T1 CECC (baseline); §P < .05 versus T1 MECC (baseline). Data are presented as means ± standard error of the mean. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 677-683DOI: (10.1016/j.jtcvs.2012.05.037) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Functional capillary density (FCD) of the sublingual microcirculation measured by OPS imaging at 4 time points: T1, after skin incision (baseline); T2, 10 minutes after aortic crossclamping; T3, 10 minutes after release of the aortic crossclamp; T4, 30 minutes after termination of cardiopulmonary bypass. The line graphs illustrate the variation of the FCD during on-pump coronary bypass grafting using conventional (CECC, n = 20 patients) and minimal (MECC, n = 20 patients) extracorporeal circulation. Asterisks denote statistically significant intergroup differences. Symbols indicate significant differences relative to baseline within each group. *P < .05 MECC versus CECC; #P < .05 versus T1 CECC (baseline); §P < .05 versus T1 MECC (baseline). Data are presented as means ± standard error of the mean. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 677-683DOI: (10.1016/j.jtcvs.2012.05.037) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Venular blood flow velocity (FCD, mm/s) of the sublingual microcirculation measured by orthogonal polarization spectral imaging at 4 time points: T1, after skin incision (baseline); T2, 10 minutes after aortic crossclamping; T3, 10 minutes after release of the aortic crossclamp; T4, 30 minutes after termination of cardiopulmonary bypass. The line graphs illustrate the variation of the FCD during on-pump bypass grafting using conventional (CECC, n = 20 patients) and minimal (MECC, n = 20 patients) extracorporeal circulation. Asterisks denote statistically significant intergroup differences. *P < .05 MECC versus CECC. Data are presented as means ± standard error of the mean. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 677-683DOI: (10.1016/j.jtcvs.2012.05.037) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions