Markers of Myocardial Ischemia in the Evaluation of the Effect of Left Anterior Descending Coronary Artery Lesion and Collateral Circulation on Myocardial Injury in 1-Vessel Off-Pump Coronary Bypass Surgery
Background: The purpose of this study was to use serum markers for myocardial tissue damage to evaluate the effect of the severity of left anterior descending artery (LAD) lesions after 1-vessel off-pump coronary artery bypass grafting.
Methods: A consecutive series of 20 patients with a totally occluded LAD and only retrograde filling (group T; n = 10) or critical stenosis (70%-99%) and only antegrade filling (group C; n = 10) were included in this study. One patient in group C who displayed no increases in the levels of markers for myocardial ischemia was excluded from the study because of the intraoperative repetition of the anastomosis. Creatine kinase activity (CK), CK-MB activity, and CK-MB mass, myoglobin, lactate, and cardiac troponin I (cTnI) concentrations were determined in venous blood samples taken immediately before and after the anastomosis and at 4, 8, 12, 24, and 48 hours postoperatively.
Results: There were no perioperative myocardial infarctions. One patient in group T developed low cardiac output syndrome 48 hours after the operation and died after 1 month. His enzyme levels did not increase in the first 2 days postoperatively. Anastomosis times were similar for the T and C groups (6.85 ± 0.9 minutes versus 8.4 ± 2.2 minutes, respectively; P = .069). The levels of all cardiac markers except cTnI increased significantly in the first 24 postoperative hours. CK-MB activity, CK-MB mass concentration, and cTnI concentration were not different between the 2 groups. Four patients in each group were evaluated for the patency of the anastomosis, and all control angiography and myocardial scanning tests showed patent anastomoses and no ischemia.
Conclusions: One-vessel off-pump coronary artery bypass grafting can be performed safely in patients with serious LAD stenosis and borderline antegrade blood flow without the need for any coronary collateral circulation support. A short anastomosis time prevents myocardial injury during off-pump coronary surgery.
Birdi I, Caputo M, Hutter JA, Bryan AJ, Angelini GD. 1997. Troponin I release during minimally invasive coronary artery surgery. J Thorac Cardiovasc Surg 114:509-10.nCarrier M, Pellerin M, Perrault LP, Solymoss BC, Pelletier LC. 2000. Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann Thorac Surg 69:435-40.nEdmunds LH. 1998. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 66:S12-6.nEigel P, van Ingen G, Wagenpfeil. 2001. Predictive value of perioperative cardiac troponin I for adverse outcome in coronary artery bypass surgery. Eur J Cardiothorac Surg 20:544-9.nInselmann G, Köhler K, Lange V, Silber R, Nellessen U. 1998. Lipid peroxidation and cardiac troponin T release during routine cardiac surgery. Cardiology 89:124-9.nIpek G, Is¸ik Ö, Yakut C. 1996. A new method used in coronary bypass surgery to have bloodless anastomatic area. Kos¸uyolu Heart J 2:153-5.nKilger E, Pichler B, Weis F, et al. 2000. Markers of myocardial ischemia after minimally and conventional coronary operation. Ann Thorac Surg 70:2023-8.nKirali K, Daglar B, Güler M, et al. 1999. Experiences of Kos¸uyolu in minimally invasive coronary artery surgery. Turkish J Thorac Cardiovasc Surg 7:25-9.nKirali K, Güler M, Daglar B, et al. 1999. Videothoracoscopic internal mammary artery harvest for coronary bypass. Asian Cardiovasc Thorac Ann 7:259-62.nKirali K, Rabus MB, Yakut N, et al. 2002. Early- and long-term comparison of the on- and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 5:177-81.nNg SM, Krishnaswamy P, Morrisey R, Clopton P, Fitzgerald R, Maisel AS. 2001. Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol 88:611-7.nOkazaki Y, Cao Z, Ohtsubo S, et al. 2000. Leukocyte-depleted reperfusion after long cardioplegic arrest attenuates ischemia-reperfusion injury of the coronary endothelium and myocardium in rabbit hearts. Eur J Cardiothorac Surg 18:90-7.nOkazaki Y, Takarabe K, Murayama J, et al. 2001. Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation. Eur J Cardiothorac Surg 19:834-9.nOmeroglu SN, Kirali K, Güler M, et al. 2000. Mid-term angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70:844-9.nPuskas JD. 2002. Invited commentary. Ann Thorac Surg 73:1417.nRivetti RA, Gandra SMA. 1997. Initial experience using an intraluminal shunt during revascularization of the beating heart. Ann Thorac Surg 63:1742-7.nWan S, Izzat MB, Lee TW, Wan IY, Tang NL, Yim AP 1999. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg 68:52-6.nYeatman M, Caputo M, Narayan P, et al. 2002. Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. Ann Thorac Surg 73:1411-7.nAscione R, Lloyd CT, Gomes WJ, Caputo M, Bryan AJ, Angelini AG. 1999. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 15:685-90.nBirdi I, Angelini GD, Bryan AJ. 1997. Biochemical markers of myocardial injury during cardiac operations. Ann Thorac Surg 63:879-84.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).