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Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study
Insights
Off-pump coronary artery bypass grafting (CABG) reduces myocardial injury and arrhythmias compared to conventional on-pump CABG. This beating heart surgery is a safe and effective alternative for myocardial revascularization.
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.
Objective:
Conventional coronary artery bypass grafting (CABG) is both safe and effective. Nevertheless, the use of cardiopulmonary bypass (CPB) and cardioplegic arrest are associated with several adverse effects. Over the last 2 years there has been a revival of interest in performing CABG on the beating heart. In this prospective randomized study we evaluated the efficacy and safety of on and off pump coronary revascularization on myocardial function.
Methods:
Eighty patients (65 males, mean age 61+/-9.7 years) undergoing first time CABG were prospectively randomized to: (i) conventional revascularization with CPB at normothermia and cardioplegic arrest with intermittent warm blood cardioplegia (on pump) or (ii) beating heart revascularization (off pump). Troponin I (Tn I) release was serially measured as a specific marker of myocardial damage. Haemodynamic measurements as well as inotropic requirement, incidence of arrhythmia and postoperative myocardial infarction were also recorded.
Results:
There were no significant differences between the two groups in terms of age, sex, extent of disease, left ventricular function and number of grafts. There were no deaths or intraoperative myocardial infarctions in either group. Tn I release was constantly lower in the off pump group and this was significant at 1, 4, 12 and 24 h postoperatively. Furthermore, in this group there was a significantly reduced incidence of arrhythmias. Inotropic requirements were less in the off pump group but this did not reach statistical significance.
Conclusion:
These results suggest that off pump coronary revascularization is a safe and effective strategy for myocardial revascularization. Myocardial injury as assessed by Tn I release is also reduced when compared with conventional coronary revascularization with CPB and cardioplegic arrest.