On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury

Rastan, Ardawan; Bittner, Hartmuth B.; Gummert, Jan; Walther, Thomas; Schewick, Claudia van; Girdauskas, Evaldes; Mohr, Friedrich W.

doi:10.1016/j.ejcts.2005.03.007

Cited by 102 publications

(75 citation statements)

References 26 publications

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“…It has been demonstrated that an on-pump beating-heart technique reduces the release of CK-MB and myocardial injury compared with conventional CABG. 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.…”

Section: Researchsupporting

confidence: 83%

“…3,24 Because most patients with left ventricular dysfunction are hemodynamically unstable and have poor perfusion of their visceral organs, the appropriate circulatory support system, such as CPB, should be applied to improve their hemodynamic status and compensate for visceral organ perfusion. 3,6,14,15,20,21 Therefore, the on-pump beating-heart technique offers a lower risk of systemic hypoperfusion during surgery and, as a consequence, superior renal protection.…”

Section: Researchmentioning

confidence: 99%

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

Erkut

Dağ

Kayğın

et al. 2013

CJS

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Section: Researchsupporting

confidence: 83%

Section: Researchmentioning

confidence: 99%

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

Erkut

Dağ

Kayğın

et al. 2013

CJS

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“…48 Even the mere use of extracorporeal circulation, independent of myocardial ischemia or necrosis, has been shown to increase the release of cardiac markers. 49 Thus, cardiac markers such as CK-MB and cTnT are presumably a poor measure of myocardial ischemia in the context of RIPC. This is supported by a recent publication on myocardial perfusion imaging.…”

Section: Limitationsmentioning

confidence: 99%

Remote Ischemic Preconditioning Preserves Mitochondrial Function and Influences Myocardial MicroRNA Expression in Atrial Myocardium During Coronary Bypass Surgery

et al. 2014

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Rationale: Remote ischemic preconditioning (RIPC) has been suggested to induce cardioprotection during cardiac surgery. Maintaining proper atrial function is imperative in preventing arrhythmia and thrombus formation. Mitochondria have been proposed as key targets in conveying RIPC mechanisms and effects. MicroRNA (miR) is emerging as an important regulator of mitochondrial function, arrhythmia, and protection from ischemia and reperfusion. Objective: This study aimed to evaluate the effect of RIPC on mitochondrial respiration and miR expression in human atrial tissue. Methods and Results: Sixty patients undergoing coronary artery bypass graft surgery were randomized to RIPC (n=30) or control (n=30). RIPC was performed preoperatively by inflating a blood pressure cuff on the upper arm to 200 mm Hg for 3×5 minutes, with 5 minutes reperfusion intervals. Biopsies were obtained from the right atrial appendage before and after aortic cross-clamping. Mitochondrial respiration was measured in situ and miR assessed by commercial miR array and quantitative reverse transcription polymerase chain reaction. Postoperative atrial fibrillation occurrence was monitored by biotelemetry. Maximal mitochondrial respiration was preserved throughout surgery after RIPC but significantly reduced (−28%; P <0.05) after aortic cross-clamping in control. Incidence of postoperative atrial fibrillation was lower after RIPC versus control (14% versus 50%; P <0.01). Myocardial expression of miR-133a and miR-133b increased after aortic cross-clamping in both RIPC and control, whereas miR-1 was upregulated in control only. MiR-338-3p expression was higher in RIPC versus control after aortic cross-clamping. Conclusions: RIPC preserves mitochondrial respiration and prevents upregulation of miR-1 in the right atrium during coronary artery bypass graft. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01308138

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“…Our observations are consistent with the findings of others that the inflammatory response, although significant in both CPB and OPCAB, is more pervasive in patients exposed to CPB. [16][17] Mechanical trauma, altered shear stresses, foreign surfaces, and hypothermia promote platelet activation in cardiopulmonary bypass, but less is known about the effects of OPCAB on platelets. In our study, CPB was associated with platelet activation, platelet-leukocyte aggregate formation, and hyperactivity of platelets, whereas OPCAB was not associated with these platelet responses.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory and Hemostatic Activation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Untch

Jeske

Schwartz

et al. 2008

Clin Appl Thromb Hemost

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procedures would be done by OPCAB; yet, in today's clinical practice, OPCAB has not reached this level of use.A recent consensus document based on a metaanalysis of published studies recommends that OPCAB should be considered in both low-risk and high-risk patients to reduce perioperative mortality, morbidity, and resource utilization beyond that achieved with CPB surgery.1 This analysis suggested that OPCAB potentially decreases perioperative myocardial infarction and other myocardial injury, stroke, atrial fibrillation, renal damage, and injury to the brain. Another study reported that OPCAB patients have decreased atrial fibrillation, transfusion and inotrope requirements, respiratory infections, ventilation time, ICU stay, and hospital stay. However, several meta-analyses showed that there is no difference (advantage) in short-term or long-term mortality and morbidity between OPCAB and on-pump cardiopulmonary bypass-coronary artery bypass grafting (CPB-CABG) as shown in observational studies.1,3,4 Moreover, they stated that C oronary artery bypass grafting (CABG) surgery using cardiopulmonary bypass (CPB) can be associated with neurological, renal, and pulmonary morbidity, as well as with inflammatory and hemostatic complications. Coronary artery bypass grafting without the use of CPB, off-pump coronary artery bypass (OPCAB) surgery, became increasingly popular in the early 1990s with the development of new techniques for coronary exposure and stabilization of the myocardium. The main advantages of OPCAB surgery over the CPB technique include less traumatic surgical intervention, shortened hospital or intensive care unit (ICU) stay, and reduced patient recovery time. It was expected that more than 50% of all coronary revascularization To characterize hemostatic differences imposed by 2 common cardiac surgeries, the authors studied patients undergoing coronary artery revascularization by offpump (n = 13) or cardiopulmonary bypass on-pump (n = 26) technique. Blood samples collected to 4 days postsurgery were evaluated by flow cytometry and enzymelinked immunosorbent assay. A significant inflammatory response occurred in both the groups after surgery shown by increased interleukin cytokines and C-reactive protein; however, levels peaked lower and hours later in the off-pump group. Platelets (P-selectin; platelet-leukocyte complexes) and leukocytes (CD11b) were activated only in on-pump patients. Thrombin generation was enhanced in both groups after surgery. Only in the on-pump patients, the thrombin-antithrombin complex, prothrombin fragment 1.2, and thrombomodulin (vascular integrity) decreased intraoperatively. Tissue plasminogen activator and plasminogen activator inhibitor-1 were greater in the on-pump patients. Off-pump surgery may place patients at higher risk of postoperative hypercoagulability because of normal platelet function, intraoperative thrombin generation, less fibrinolytic activity, and lack of vascular protection.

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On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury

Abstract: In this randomized study on routine coronary patients with normal ventricular function, OPCAB revealed less myocardial injury than OnP-BH. These findings implicate that CPB slightly affects the myocardium.

Cited by 102 publications

References 26 publications

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

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

Remote Ischemic Preconditioning Preserves Mitochondrial Function and Influences Myocardial MicroRNA Expression in Atrial Myocardium During Coronary Bypass Surgery

Inflammatory and Hemostatic Activation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

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