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Myocardial metabolism and hemodynamics during coronary surgery without cardiopulmonary bypass
H J Penttilä1, M V Lepojärvi, P K Kaukoranta
1Department of Anesthesiology, Oulu University Hospital, Finland. hannu.penttila@oulu.fi
Insights
Coronary artery bypass grafting without cardiopulmonary bypass showed minor myocardial metabolic and hemodynamic changes during surgery. This technique appears well-tolerated, with minimal postoperative cardiac enzyme release.
Area of Science:
- Cardiovascular Surgery
- Cardiac Metabolism
- Hemodynamics
Background:
- Growing interest in off-pump coronary artery bypass grafting (CABG).
- Limited data on myocardial metabolism and hemodynamics during off-pump procedures with heart manipulation.
Purpose of the Study:
- To evaluate myocardial energy metabolism and hemodynamics during off-pump CABG.
- To assess postoperative cardiac enzyme release (creatine kinase-MB mass and troponin T).
Main Methods:
- Monitored myocardial metabolism and hemodynamics in 12 patients undergoing off-pump CABG.
- Measured postoperative troponin T and creatine kinase-MB mass levels.
Main Results:
- Increased myocardial ATP degradation products and lactate production observed.
- Decreased myocardial oxygen extraction correlated with esmolol use.
- Minor hemodynamic changes, including a drop in mean arterial blood pressure, noted.
- Postoperative cardiac enzymes remained largely unchanged, with one instance of myocardial infarction.
Conclusions:
- Off-pump CABG is generally well-tolerated.
- Minor alterations in myocardial energy metabolism and hemodynamics occur during the procedure.
- The technique demonstrates a favorable safety profile with minimal impact on myocardial injury markers.
Background:
Although renewed interest has recently been shown in coronary artery bypass grafting without cardiopulmonary bypass, no reports are available on myocardial metabolism and hemodynamics during temporary coronary occlusion and rotation of the contracting heart.
Methods:
Changes in myocardial energy metabolism and hemodynamics were monitored in 12 patients undergoing elective coronary artery bypass grafting without cardiopulmonary bypass, and the postoperative efflux of creatine kinase-MB mass and troponin T were also determined.
Results:
There was a significant increase in myocardial production of ATP degradation products (p = 0.026) and lactate (p = 0.004) during the operation. Myocardial oxygen extraction decreased (p = 0.012) in correlation with use of the short-acting beta-blocker, esmolol (r = -0.71). Apart from a decrease in mean arterial blood pressure (p = 0.002), there were no significant hemodynamic changes during the operation. The overall postoperative troponin T and creatine kinase-MB mass changes remained nonsignificant during the first two postoperative days. One patient had a myocardial infarction, diagnosed by electrocardiography, on the second postoperative day, but otherwise there were no major complications.
Conclusions:
Coronary artery bypass grafting without cardiopulmonary bypass seems to be well tolerated as only minor changes in myocardial energy metabolism and hemodynamics are observed during the operation.