Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Conventional coronary artery bypass grafting (CABG) utilizes cardiopulmonary bypass (CPB) and cardioplegic arrest, which can lead to adverse effects.
• There is a renewed interest in performing CABG on a beating heart (off-pump) to mitigate these risks.

Purpose of the Study:

• To prospectively evaluate the efficacy and safety of on-pump versus off-pump coronary revascularization on myocardial function.
• To compare myocardial damage, hemodynamic stability, and postoperative complications between the two surgical approaches.

Main Methods:

• Eighty patients undergoing first-time CABG were randomized into two groups: on-pump conventional CABG or off-pump beating heart CABG.
• Myocardial damage was assessed by serial Troponin I (Tn I) release measurements.
• Hemodynamic parameters, inotropic requirements, arrhythmias, and myocardial infarction incidence were recorded.

Main Results:

• No significant differences in patient demographics or graft numbers were observed between the groups.
• Troponin I release was significantly lower in the off-pump group at multiple postoperative time points.
• The off-pump group experienced a significantly reduced incidence of arrhythmias.

Conclusions:

• Off-pump coronary revascularization is a safe and effective strategy for myocardial revascularization.
• Beating heart surgery significantly reduces myocardial injury, as indicated by lower Troponin I release, compared to conventional on-pump CABG.