Thorac Cardiovasc Surg 2007; 55 - V_149
DOI: 10.1055/s-2007-967526

Effect of cardiopulmonary bypass, OPCAB and Impella blood pump assisted coronary artery bypass grafting on visceral perfusion and function in an adult porcine model

B Bierbach 1, H Pritzer 2, W Kasper-König 3, M Dahm 3, O Kempski 2, G Horstick 4, H Oelert 3
  • 1Universitätsklinik Saarland, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Homburg, Germany
  • 2Universität Mainz, Institut für Neurochirurgische Pathophysiologie, Mainz, Germany
  • 3Universitätsklinik Mainz, Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
  • 4Universitätsklinik Mainz, II. Medizinische Klinik, Mainz, Germany

Objectives: Visceral organ failure after CABG results in high morbidity and mortality. This study was designed to evaluate the effect on visceral perfusion and organ function following internal mammary to left anterior descending coronary artery bypass in a porcine model.

Methods: Three surgical techniques were applied: cardiopulmonary bypass (CPB) and cardioplegic arrest (n=8), OPCAB (n=8), Impella® elect 100 assistance during OPCAB (n=8) and eight control animals.

Visceral perfusion (VP) was assessed in 57 biopsies from both kidneys, intestinum, pancreas, liver and splen with microspheres. Creatinin-Clearance, arterial lactat-concentration, pancreatic and liver enzymes (GOT, GGT, GLDH and GPT) were measured. These variables were analysed 20 minutes before, several times during the procedure and throughout 4 hours of reperfusion.

Results: During CPB arterial lactat concentration significantly increased (p<0.05). Intestinal perfusion remained unchanged. Renal and pancreatic perfusion were significantly reduced (p<0.05). Creatinin-clearance significantly decreased after CPB (p<0.05). Pancreatic enzymes showed no disturbance during the observation period. GOT was elevated significantly after surgery in all groups (p<0.05). During OPCAP surgery VP decreased only slightly. Renal functional parameters and pancreatic enzymes remained unchanged. During Impella assistance VP moderately decreased and recovered delayed to baseline values. Laboratory testing showed no significant changes. Splen and liver perfusion revealed no remarkable changes in either group.

Conclusions: Normothermic high-flow CPB results in reduced renal and pancreatic perfusion with consecutive decrease in creatinin-clearance. In contrast OPCAB leads to slightly decreased visceral perfusion without adverse effects on organ function. Visceral perfusion cannot be improved by the Impella-pump, however no significant adverse changes in laboratory parameters are observed.