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Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
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1999 (English)In: Journal of cardiothoracic and vascular anesthesia, ISSN 1053-0770, Vol. 13, no 4, 431-436 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting β-blocker.

Design: A retrospective study.

Setting: A university hospital.

Participants: Seventeen patients scheduled for elective CABG.

Interventions: Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting β-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe.

Measurements and main results: Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and β-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital.

Conclusion: The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting β-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.

Place, publisher, year, edition, pages
1999. Vol. 13, no 4, 431-436 p.
Keyword [en]
coronary artery bypass grafting, beating heart surgery, axial flow pump, β-blocker
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13609DOI: 10.1016/S1053-0770(99)90215-XOAI: diva2:21052
Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2009-08-20
In thesis
1. Management of patients treated with left ventricular assist devices: A clinical and experimental study
Open this publication in new window or tab >>Management of patients treated with left ventricular assist devices: A clinical and experimental study
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described.

An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure.

A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. 79 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 677
postcardiotomy heart failure, perioperative monitoring, coronary artery bypass, heart-assist devices, heart failure, congestive, ventricular dysfunction
National Category
urn:nbn:se:liu:diva-5151 (URN)91-7219-969-5 (ISBN)
Public defence
2001-05-21, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 00:00 (English)
On the day of the public defence the status of the article IV was: Submitted for publication.Available from: 2001-06-12 Created: 2001-06-12 Last updated: 2012-01-24Bibliographically approved

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