Impact of Coronary Collateral Circulation of Perioperative Myocardial Damage in High-Risk Patients Undergoing Coronary Artery Bypass Grafting Surgery
DOI:
https://doi.org/10.1532/hsf.2483Abstract
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.
Published
How to Cite
Issue
Section
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).
