• Fernando G Resano, Emmanouil I Kapetanakis, Peter C Hill, Elizabeth Haile, and Paul J Corso.
• Department of Anesthesiology, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010-2975, USA. resano@medstar.net
• J. Cardiothorac. Vasc. Anesth. 2006 Jun 1; 20 (3): 300-6.

ObjectiveFor patients who undergo off-pump coronary artery bypass (OPCAB) surgery, pulmonary artery catheterization (PAC) has been proposed as a useful intraoperative monitoring tool. This study was designed to determine if the choice of PAC versus central venous pressure monitoring (CVP) had any effect on outcome after OPCAB. This study compared these 2 methods of hemodynamic monitoring in low-risk patients undergoing beating-heart surgery via a median sternotomy and evaluated their effect on morbidity and in-hospital mortality.DesignRetrospective database and medical record review.SettingTertiary care teaching hospital.ParticipantsLow-risk patients who had coronary revascularization via a median sternotomy on the beating heart.InterventionsNone.Measurements And Main ResultsA population of 2,414 low-risk patients who had beating-heart coronary revascularization between January 2000 and December 2003 was reviewed. Most patients (1,671 or 69.2%) received a PAC, whereas 743 (30.8%) had CVP monitoring. Risk-adjusted logistic regression analyses were performed to investigate the effect of each technique on clinical outcomes. The groups were comparable in both baseline characteristics and Parsonett's mortality risk (1.5 +/- 0.9, p = 0.58). Univariate analysis failed to show a difference in operative mortality (p = 0.76), on-pump conversion rate for completion of aortocoronary bypasses (p = 0.82), postoperative low cardiac output (p = 0.10), or prolonged inotropic agent use (p = 0.22). Similarly, in the multivariate analysis, both groups had a similar rate of conversion to an on-pump procedure for completion of coronary artery grafting (p = 0.91), intraoperative intra-aortic balloon pump use (p = 0.69), low cardiac output state (p = 0.16), or in-hospital mortality (p = 0.51).ConclusionsThis single-institution, retrospective study suggests that in low-risk patients undergoing beating-heart surgery, CVP monitoring may be sufficient.

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