• Nick J Koning, Alexander B A Vonk, Thomas Oomens, and Melissa Verkaik.
• Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardio-Thoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardio-Thoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: n.koning@vumc.nl.
• J. Cardiothorac. Vasc. Anesth.. 2014 Apr 1;28(2):336-41.

ObjectiveThis study investigated the perioperative course of microcirculatory perfusion in off-pump compared with on-pump surgery. Additionally, the impact of changes in systemic hemodynamics, hematocrit, and body temperature was studied.DesignProspective, nonrandomized, observational study.SettingTertiary university hospital.ParticipantsPatients undergoing coronary artery bypass grafting with (n = 13) or without (n = 13) use of cardiopulmonary bypass.InterventionsMicrocirculatory measurements were obtained at 5 time points ranging from induction of anesthesia to ICU admission.Measurements And Main ResultsMicrocirculatory recordings were performed with sublingual sidestream dark field imaging. Despite a comparable reduction in intraoperative blood pressure between groups, the perfused vessel density decreased more than 20% after onset of extracorporeal circulation but remained stable in the off-pump group. The reduction in microvascular perfusion in the on-pump group was further paralleled by decreased hematocrit and temperature. Although postbypass hematocrit levels and body temperature were restored to similar levels as in the off-pump group, the median microvascular flow index remained reduced after bypass (2.4 [2.3-2.7]) compared with baseline (2.8 [2.7-2.9]; p = 0.021).ConclusionsMicrocirculatory perfusion remained unaltered throughout off-pump surgery. In contrast, microvascular perfusion declined after initiation of cardiopulmonary bypass and did not recover in the early postoperative phase.Copyright © 2014 Elsevier Inc. All rights reserved.

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