Impact of Coronary Collateral Circulation of Perioperative Myocardial Damage in High-Risk Patients Undergoing Coronary Artery Bypass Grafting Surgery
Abstract
Background: Coronary collateral circulation (CCC) is a small vascular formation that allows the connection between the different parts of an epicardial vessel or other vessels. The presence of collateral circulation contributes positively to the course of coronary artery disease (CAD). The aim of this study was to investigate the effect of collateral circulation on myocardial injury and clinical outcomes during coronary artery bypass grafting (CABG) in a high-risk patient group.
Methods: 386 patients who underwent isolated CABG under cardiopulmonary bypass (CPB) were included in the study. Patients were divided into two groups according to the Rentrop scores (n = 225 poor CCC group; and n = 161 good CCC group). Myocardial injury and postoperative clinical results were evaluated as endpoints.
Results: The mean age was 62.9 ± 7.5 years, and 61.6% of all patients were male. Postoperative 30-day mortality rate was significantly higher in poor CCC group (4 [1.7%] and 1 [0.6%], P < .001). The frequency of postoperative intraaortic balloon pump (IABP) use (5 [2.2%] and 1 [0.6%],
P < .001), low cardiac output syndrome (LCOS) (28 [12.4%] and 10 [6.2%], P < .001) and postoperative atrial fibrillation (35 [15.6%] and 16 [9.9%], P = .038) were significantly higher in poor CCC group. 12th and 24th hour CK-MB and cTn-I values were found to be significantly lower in the good CCC group.
Conclusion: It is inevitable that the CPB circuit and operation have devastating effects on myocardium in CABG operations. The presence of CCC reduces postoperative myocardial injury, low cardiac output syndrome, and mortality rates.
References
Adabag AS, Rector T, Mithani S, et al. 2007. Prognostic significance of elevated cardiac troponin I after heart surgery. Ann Thorac Surg 83:1744-50.
Aldous SJ. 2013. Cardiac biomarkers in acute myocardial infarction. Int J Cardiol 164:282-94.
Caputo M, Anis RR, Rogers CA, et al. 2008. Coronary collateral circulation: effect on early and midterm outcomes after off-pump coronary artery bypass surgery. Ann Thorac Surg 85:71-9.
Croal BL, Hillis GS, Gibson PH, et al. 2006. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation 114:1468-75.
De Marchi SF, Gloekler S, Meier P, et al. 2011. Determinants of preformed collateral vessels in the human heart without coronary artery disease. Cardiology 118:198-206.
Ding W, Ji Q, Shi Y, Ma R. 2015. Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting. Int Heart J 56:144-9.
Domanski MJ, Mahaffey K, Hasselblad V, et al. 2011. Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery. JAMA 305:585-91.
Guan Y, Cai B, Liu Z, et al. 2016. The formation of aberrant collateral vessels during coronary arteriogenesis in dog heart. Cells Tissues Organs 201:118-29.
Laflamme M, DeMey N, Bouchard D, et al. 2012. Management of early postoperative coronary artery bypass graft failure. Interact Cardiovasc Thorac Surg 14:452-6.
McMurtry MS, Lewin AM, Knudtson ML, et al. 2011. The clinical profile and outcomes associated with coronary collaterals in patients with coronary artery disease. Can J Cardiol 27:581-8.
Meier P, Gloekler S, Zbinden R, et al. 2007. Beneficial effect of recruitable collaterals: A 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation 116:975-83.
Nathoe HM, Buskens E, Jansen EWL, et al. 2004. Role of coronary collaterals in off-pump and on-pump coronary bypass surgery. Circulation 110:1738-42.
Paparella D, Guida P, Caparrotti S, et al. 2014. Myocardial damage influences short- and mid-term survival after valve surgery: A prospective multicenter study. J Thorac Cardiovasc Surg 148:2373-9.e1.
Piek JJ, Van Liebergen RAM, Koch KT, Peters RJG, David GK. 1997. Clinical, angiographic and hemodynamic predictors of recruitable collateral flow assessed during balloon angioplasty coronary occlusion. J Am Coll Cardiol 29:275-82.
Rentrop KP, Thornton JC, Feit F, Van Buskirk M. 1988. Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol 61:677-84.
Seiler C. 2013. Assessment and impact of the human coronary collateral circulation on myocardial ischemia and outcome. Circ Cardiovasc Interv 6:719-28.
Sianos G, Morel M-A, Kappetein AP, et al. 2005. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. Euro Intervention 1:219-27.
Werner GS, Ferrari M, Betge S, Gastmann O, Richartz BM, Figulla HR. 2001. Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion. Circulation 104:2784-90.
Wustmann K, Zbinden S, Windecker S, Meier B, Seiler C. 2003. Is there functional collateral flow during vascular occlusion in angiographically normal coronary arteries? Circulation 107:2213-20.
Yaylak B, Altintas B, Ede H, et al. 2015. Impact of coronary collateral circulation on in-hospital death in patients with inferior st elevation myocardial infarction. Cardiol Res Pract 2015.
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