Off-pump coronary artery bypass grafting
(OP-CABG) has revolutionized the surgical approach for the treatment of
coronary artery disease. OP-CABG avoids the use of extracorporeal circulation,
and hence all the detrimental effects of instituting cardiopulmonary bypass
(CPB), especially the systemic inflammatory response syndrome, are eliminated
in patients who undergo this technique of coronary revascularization. Essential
to the performance of OP-CABG is the use of mechanical stabilizers, for example
octopus II and/or starfish, which make the distal anastomotic site immobile
during grafting. In addition to mechanical stabilization, manipulation of the
heart to provide access to the distal anastomotic site is necessary for
optional visualization. Use of mechanical stabilizers and manipulation of the
heart for optimal position prior to grafting makes the hemodynamic state
unsteady and is associated with fall in cardiac output (CO) and systemic
hypotension. Hemodynamic assessment involving CO measurement is of particular
importance in patients undergoing OP-CABG. The intermittent thermodilution
bolus techniques using a pulmonary artery catheter is still accepted as a
standard method for measurement of CO, despite its invasive character and associated
risks. Recently, less invasive methods and hardware to assess CO have become
available. One of these alternatives is the FloTrac/Vigileo system (Edwards
Life sciences, Irvine, California, United States), which determines CO by analyzing
the peripheral arterial waveform of an artery. FloTrac is easy to install, safe
to use, and does not need any specific catheter or external calibration.
FloTrac is based on the following equation: stroke volume (SV) = pulsatility ×
kappa. Pulsatility is calculated by using the standard deviation (SD) of a
peripheral arterial pressure wave. Kappa is a number that represents the
vascular tone of the patient’s arterial tree, and it takes [CE1] into account the age, weight, height, and

The FloTrac sensor has been proven accurate
and reliable in monitoring CO in clinical studies when compared against
continuous cardiac output (CCO) and intermittent cardiac output (ICO).1 A prior study found satisfactory agreement of
the new device with intermittent and continuous thermodilution.2 Good agreement was found between CO values
obtained by arterial pulse contour analysis and thermodilution technique using
PAC in the intraoperative period in patients undergoing OP-CABG.3 Rose-Marieke have demonstrated that CO
measured by a new arterial pressure waveform analysis using FloTrac/Vigileo is clinically
applicable after cardiac surgery and performs well at low CO.4

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