Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and off-pump beating heart

Abstract

Coronary bypass grafting without aortic cross-clamping and without CPB offers superior myocardial protection.

Off-pump surgery for the poor ventricle?

“…Pathophysiologically, this is reflected by an extended degree of inflammatory response [4] and myocardial injury [20,21], especially if the CPB run is prolonged [10]. The activation of numerous inflammatory mediators may compromise myocardial performance, particularly if the LV function is already severely impaired [22,23].…”

On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes

“…12,13,15,19,20 Early surgical outcomes were better in the on-pump beatingheart group in our study, and this result is consistent with those reported in several studies. [18][19][20][21] Postoperative LCOS ratios, perioperative infarction, new IABP insertion (for weaning from the CPB), and duration of inotropic support were significantly lower in the onpump beating-heart group than the conventional group. Postoperatively, intensive care unit and hospital stay as well as hospital costs decreased in the on-pump beatingheart group.…”

“…Krejca and colleagues 18 found that troponin T levels were higher with conventional CABG than with on-or off-pump beating-heart techniques. Patients with left ventricular dysfunction may be unable to sustain an adequate intraoperative cardiac output during the beating-heart technique; hence, the theoretical need exists for mechanical support from a CPB circuit as a hybrid procedure.…”

Cariporide (HOE-642) improves cardiac allograft preservation in a porcine model of orthotopic heart transplantation

“…A similar benefit was seen in the surgical arm of the Guardian trial (6), in which peak cardiac enzyme levels were significantly lower in the subgroup receiving cariporide at an equivalent dose to that used in the present study. Although the release of cardiac enzymes and troponin reflect the effects of both ischemia and surgical trauma, there is evidence in the literature that postoperative levels correlate well with the severity of ischemic injury and clinical outcome (28,29).…”