Pulse-Pressure Variation Predicts Fluid Responsiveness During Heart Displacement for Off-Pump Coronary Artery Bypass Surgery

Objective: The aim of this study was to evaluate the ability of pulse-pressure variation to predict fluid responsiveness during heart displacement for off-pump coronary artery bypass surgery using receiver operating characteristic analysis. Design: A prospective study. Setting: A clinical study in a single cardiac anesthesia institution. Participants: Thirty-five patients undergoing elective off-pump coronary artery bypass surgery. Measurements and Main Results: Central venous pressure, pulmonary arterial occlusion pressure, pulse-pressure variation, and cardiac index were measured 5 minutes after revascularization of the left anterior descending coronary artery and before heart displacement. Immediately after heart displacement for revascularization of the left circumflex artery, and 10 minutes after fluid loading with hydroxyethyl starch 6% (10 mL/kg) during heart displacement, the measurements were repeated. Patients whose cardiac indices increased by >= 15% from fluid loading were defined as responders. After heart displacement, only pulse-pressure variation showed significant difference between the responders and nonresponders (13.48 +/- 6.42 v 7.33 +/- 3.81, respectively; p < 0.01). Moreover, receiver operating characteristic analysis showed that pulse-pressure variation successfully predicted fluid responsiveness (area under the curve = 0.839, p = 0.0001). Pulse-pressure variation >7.69% identified the responders, with a sensitivity of 86% and a specificity of 83%. Conclusions: Pulse-pressure variation successfully predicted fluid responsiveness and would be useful in guiding fluid management during heart displacement for off-pump coronary artery bypass surgery. (C) 2011 Elsevier Inc. All rights reserved.