Key result
Cardiopulmonary bypass surgery significantly increased basal coronary blood flow from 27 to 47 ml/min at 5 days postoperatively in infants with ventricular left-to-right shunts.
Why the study?
Does cardiopulmonary bypass surgery alter coronary blood flow and artery diameter in children compared to off-pump surgery?
Observational (n=104)
No
Does cardiopulmonary bypass surgery alter coronary blood flow and artery diameter in children compared to off-pump surgery?
Cardiopulmonary bypass surgery in children is associated with an increase in basal coronary flow, which may explain previously reported impairments in coronary flow reserve.
May explain impaired coronary flow reserve after bypass in infants; hypothesis-generating for off-pump comparisons and outcomes.
Perturbation of coronary blood flow (CF) is an important contributor to myocardium-related complications. The study was primarily designed to assess the impact of cardiopulmonary bypass (CPB) surgery on CF by aid of transthoracic Doppler echocardiography. Changes in CF after off-pump coarctation surgery were also studied. All ultrasounds were performed before and 5 +/- 1 days after surgery. Eighteen children underwent CPB surgery of ventricular left-to-right shunts at the mean age of 6 mo, while off-pump surgery (aortic coarctectomy) was undertaken at the mean age of 10 days in 12 children. After CPB surgery, both left anterior descending coronary artery mean diameter and basal CF increased from 1.7 +/- 0.3 to 2.1 +/- 0.4 mm (P = 0.001) and 27 +/- 10 to 47 +/- 15 ml/min (P = 0.0001), respectively. These two coronary variables decreased after off-pump coarctectomy: left anterior descending coronary artery mean diameter from 1.8 +/- 0.1 to 1.7 +/- 0.1 mm (P = 0.06), and CF from 44 +/- 12 to 25 +/- 8 ml/min (P = 0.001). The findings are in keeping with the hypothesis that the previously reported impairment of coronary flow reserve after CPB surgery could be due to increase in basal coronary flow after CPB. Off-pump coarctectomy seems to have little impact on CF, as the postsurgical decline in flow in these patients seems to relate to the reduction in cardiac pressure afterload.
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Aburawi et al. (2007) conducted an observational in Congenital heart disease (n=104). Cardiopulmonary bypass surgery vs. Preoperative baseline was evaluated on Basal coronary blood flow (CF) (p=0.0001). Cardiopulmonary bypass surgery significantly increased basal coronary blood flow from 27 to 47 ml/min at 5 days postoperatively in infants with ventricular left-to-right shunts.
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