Hemodynamic effects of carbon dioxide insufflation during endoscopic vein harvesting

Background. A prospective study was performed assessing the hemodynamic effects of carbon dioxide (CO₂) insufflation during endoscopic vein harvesting (EVH) using the Guidant Vasoview Uniport system. Methods. Five hemodynamic and respiratory parameters (end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, mean arterial pressure, mean pulmonary arterial pressure, and cardiac output), were measured in 100 consecutive patients undergoing EVH with CO₂ insufflation. Data were obtained prior to commencement of EVH, 15 minutes after commencement, and 5 minutes after completion of the vein harvesting. Results. No adverse hemodynamic effects were observed during CO₂ insufflation. Specifically, average mean arterial pressure went from 88.77 ± 9.64 to 89.13 ± 8.60 to 88.24 ± 8.71 mm Hg before, during, and after endoscopic vein harvesting (p = 0.291). Likewise, average mean pulmonary artery pressures were 19.76 ± 4.75, 20.05 ± 4.48, and 20.05 ± 4.62 mm Hg (p = 0.547); and average cardiac output was 4.25 ± 0.74, 4.22 ± 0.73, and 4.23 ± 0.69 L/min (p = 0.109) at those three intervals. Additionally, there was no evidence of significant systemic absorption of CO₂ as reflected in average arterial Pco₂, which remained steady at 37.42 ± 5.19, 37.51 ± 4.59, and 38.10 ± 4.80 mm Hg (p = 0.217); and average end-tidal CO₂, which was 32.10 ± 3.66, 32.50 ± 3.47, and 32.38 ± 3.33 mm Hg (p = 0.335). In a subset of 20 patients with elevated pulmonary arterial pressure (more than 32 mm Hg), there was also no significant change in any of the parameters. Conclusions. Carbon dioxide insufflation during EVH leads to no adverse hemodynamic consequences or systemic CO₂ absorption. The technique appears to be safe and well tolerated. (C) 2000 by The Society of Thoracic Surgeons.