Care guided by tissue oxygenation and haemodynamic monitoring in off-pump coronary artery bypass grafting (Bottomline-CS): assessor blind, single centre, randomised controlled trial

Dear Editor
Han et al. 2025 explore the potential benefits of near-infrared spectroscopy (NIRS) for guiding clinical decision-making and improving patient outcomes. The outcomes underscore a significant reduction in perioperative complications and a trajectory towards enhanced graft patency in patients receiving targeted care based on real-time NIRS evaluation [1]. Thus, the findings suggest that integrating tissue oxygenation data can offer more precise management, especially in high-risk cardiovascular patients.

This study demonstrated that patients in the NIRS-guided cohort experienced fewer incidents of low oxygen saturation and metabolic derangements. Improved tissue perfusion culminates in reduced rates of organ dysfunction [2]. There is a serious need to optimise oxygen delivery and maintain hemodynamic stability, especially in off-pump CABG, where coronary flow is often compromised due to the lack of cardiopulmonary bypass [3].

Interestingly, the study equally explores the potential role of NIRS in predicting longer-term outcomes. Although the primary focus was on perioperative outcomes, the enhanced oxygenation and tissue perfusion observed in surgery could theoretically reduce postoperative morbidity [4]. The follow-up data, though limited, suggest that a well-oxygenated tissue environment may contribute to better long-term graft function.

Nevertheless, while the results are promising, there remains uncertainty regarding the widespread applicability of NIRS, particularly outside specialised centres. The single-centre design may limit the generalisability of the findings, and extra multicentre studies would be necessary to confirm whether these results can be replicated in diverse patient populations [5].

In conclusion, the findings from this trial offer compelling evidence for the integration of NIRS in off-pump CABG. By providing real-time insights into tissue oxygenation and hemodynamics, NIRS-guided care could reduce complications and optimise patient recovery.

References
[1] Han J, Zhai W, Wu Z, Zhang Z, Wang T, Ren M, et al. Care guided by tissue oxygenation and haemodynamic monitoring in off-pump coronary artery bypass grafting (Bottomline-CS): assessor blind, single centre, randomised controlled trial. BMJ. 2025 Mar 24;e082104.
[2] Parker T, Brealey D, Dyson A, Singer M. Optimising organ perfusion in the high-risk surgical and critical care patient: a narrative review. British Journal of Anaesthesia. 2019 Aug;123(2):170–6.
[3] Heusch G. Myocardial ischemia: lack of coronary blood flow, myocardial oxygen supply-demand imbalance, or what? American Journal of Physiology-Heart and Circulatory Physiology. 2019 Jun 1;316(6):H1439–46.
[4] Gurgel ST, do Nascimento P. Maintaining Tissue Perfusion in High-Risk Surgical Patients. Anesthesia & Analgesia. 2011 Jun;112(6):1384–91.
[5] Bellomo R, Warrillow SJ, Reade MC. Why we should be wary of single-center trials. Critical Care Medicine. 2009 Dec;37(12):3114–9.