Comparison of two strategies for myocardial management during coronary artery operations

Anderson, Jonathan; Hossein-Nia, M; Kallis, P; Pye, Maurice; Holt, David W.; Murday, Andrew J.; Treasure, Tom

doi:10.1016/0003-4975(94)90745-5

Cited by 46 publications

(17 citation statements)

References 22 publications

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“…It was our aim in the present study to compare the extent of myocardial damage associated with these two techniques using cardiac troponin T,13 17 18 a specific marker with negligible cross reactivity with skeletal muscle 10. In addition, we aimed to increase the sensitivity of this method still further by estimating cardiac troponin T in both coronary sinus and peripheral artery, so that myocardial release could be detected 7…”

Section: Discussionmentioning

confidence: 99%

Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass

Koh

Carr‐White

DeSouza

et al. 1999

Heart

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Objective-To compare cardiac troponin T release and lactate metabolism in coronary sinus and arterial blood during uncomplicated coronary grafting on the beating heart with conventional coronary grafting using cardiopulmonary bypass. Design-A prospective observational study with simultaneous sampling of coronary sinus and arterial blood: before and 1, 4, 10, and 20 minutes after reperfusion for analysis of cardiac troponin T and lactate. Cardiac troponin T was also analysed in venous samples taken 3, 6, 24, 48, and 72 hours after surgery. Setting-Cardiac surgical unit in a tertiary referral centre. Patients-18 patients undergoing coronary grafting on the beating heart (10 single vessel and eight two-vessel grafting) and eight undergoing two-vessel grafting with cardiopulmonary bypass. Results-Cardiac troponin T was detected in coronary sinus blood in all patients by 20 minutes after beating heart coronary artery surgery before arterial concentrations were consistently increased. Peak arterial and coronary sinus cardiac troponin T values on the beating heart during single (0.03 (0 to 0.05) and 0.09 (0.07 to 0.16 µg/l, respectively) and two-vessel grafting (0.1 (0.07 to 0.11) and 0.19 (0.14 to 0.25) µg/l) were lower than the values obtained during cardiopulmonary bypass (0.64 (0.52 to 0.72) and 1.4 (0.9 to 2.0) µg/l) (p < 0.05). The area under the curve of venous cardiac troponin T over 72 hours for two-vessel grafting on the beating heart was less than with cardiopulmonary bypass (13 (10 to 16) v 68 (26 to 102) µg.h/l) (p < 0.001). Lactate extraction began within one minute of snare release during beating heart coronary surgery while lactate was still being produced 20 minutes after cross clamp release following cardiopulmonary bypass. Conclusions-Lower intraoperative and serial venous cardiac troponin T concentrations suggest a lesser degree of myocyte injury during beating heart coronary artery surgery than during cardiopulmonary bypass. Oxidative metabolism also recovers more rapidly with beating heart coronary artery surgery than with conventional coronary grafting. Coronary sinus cardiac troponin T concentrations increased earlier and were greater than arterial concentrations during beating heart surgery, suggesting that this may be a more sensitive method of intraoperative assessment of myocardial injury. (Heart 1999;81:495-500) Keywords: beating heart coronary artery surgery; troponin T; cardiopulmonary bypass; intraoperative assessment; myocardial injury Beating heart coronary artery surgery, in avoiding the need for cardioplegic arrest and aortic clamping, may limit the ischaemic damage to the myocardium and interference with the cerebral circulation associated with conventional cardiopulmonary bypass. However, doubts have been expressed as to whether local coronary occlusion necessary to obtain a bloodless field may itself cause ischaemic damage in a warm metabolically active heart. 1 We have therefore correlated the early myocardial release and later venous concentrations of cardiac troponin...

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Section: Discussionmentioning

confidence: 99%

Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass

Koh

Carr‐White

DeSouza

et al. 1999

Heart

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“…In fact, several randomised clinical studies have shown that intermittent aortic cross clamping provides protection that is equivalent to, if not better than, blood cardioplegia and preserves LV diastolic function better. [15][16][17][18] We and others have previously shown the safety and efficacy of these methods, even in higher risk patients, possibly because during the operation the myocardium is continuously perfused with the patient's unaltered blood. 8 19-21 The use of off-pump coronary bypass in this subgroup of patients has recently been studied with respect to early outcomes.…”

Section: 7 9 11mentioning

confidence: 99%

Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results

Antunes

Oliveira²,

Antunes³

2003

Heart

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Objective: To evaluate perioperative results and long term survival in patients with severe left ventricular (LV) dysfunction undergoing coronary artery bypass grafting (CABG) using non-cardioplegic methods. Methods: From April 1990 through December 1999, 4100 consecutive patients underwent isolated CABG using hypothermic ventricular fibrillation. Of these, 141 (3.4%) had severe LV dysfunction (ejection fraction < 30%). Mean age was 58.3 (9.6) years. 64 patients (45.4%) were in Canadian Cardiovascular Society class III or IV and 16 (11.3%) were subjected to urgent or emergent surgery. A previous myocardial infarction was recorded in 127 (90.1%). The majority (89.4%) had triple vessel and 26 (18.4%) had left main disease. The mean number of grafts per patient was 3.1. At least one internal thoracic artery was used in all patients and 21 (14.8%) had bilateral internal thoracic artery grafts (1.2 arterial grafts per patient). Results: Perioperative mortality was 2.8% (4 patients) and the incidence of acute myocardial infarction 2.8%. 50 (35.5%) patients required inotropes but only 16 (11.3%) required it for longer than 24 hours; 5 patients (3.5%) needed mechanical support. The incidence of renal failure was 3.5%. Mean duration of hospital stay was 9.6 (8.3) days. Follow up was 95% complete and extended for a mean of 57 (30) months. Late mortality was 11.5%. Actuarial survival rates at 1, 3, and 5 years were 96%, 91%, and 86%, respectively. Conclusions: Non-cardioplegic techniques are safe and effective in preserving the myocardium during CABG in patients with coronary artery disease and poor LV function, with low operative mortality and morbidity, and encouraging medium to long term survival rates.

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“…Since 1982, there have been a number of clinical trials comparing cardioplegia with ischemic arrest in a prospective randomized manner. 3,4,[9][10][11][12] None showed significant superiority of cardioplegia over intermittent ischemic fibrillatory arrest.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Wong

Vendargon

Lim

2000

Asian Cardiovasc Thorac Ann

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From November 1996 to April 1999 patients underwent isolated noncardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.

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Comparison of two strategies for myocardial management during coronary artery operations

Cited by 46 publications

References 22 publications

Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass

Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass

Coronary surgery with non-cardioplegic methods in patients with advanced left ventricular dysfunction: immediate and long term results

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

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