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Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and
M Krejca1, J Skiba, P Szmagala
11st Cardiac Surgery Department, Silesian Heart Center, Katowice, Poland.
Insights
Coronary artery bypass grafting without aortic cross-clamping and cardiopulmonary bypass (CPB) demonstrates superior myocardial protection. This method results in lower troponin T (TnT) release, a key marker of heart muscle damage, compared to traditional techniques.
Area of Science:
- Cardiovascular Surgery
- Cardiac Biomarkers
- Myocardial Protection Strategies
Background:
- Troponin T (TnT) is a specific indicator of myocardial cell damage.
- Assessing TnT release is crucial in cardiac surgery patients.
- Different myocardial protection strategies may influence TnT release.
Purpose of the Study:
- To compare intra-operative troponin T (TnT) release.
- To evaluate three distinct myocardial protection strategies during cardiac surgery.
Main Methods:
- Thirty-eight patients undergoing myocardial revascularization were randomized into three groups.
- Group I: intermittent aortic cross-clamp.
- Group II: beating-heart on pump without aortic cross-clamp.
- Group III: beating-heart without extracorporeal circulation (CPB).
- Serial TnT measurements and hemodynamic monitoring were performed.
Main Results:
- No significant differences in hospital deaths, myocardial infarction (MI), or postoperative hemodynamics were observed.
- Troponin T (TnT) serum levels were significantly higher in Group I (intermittent cross-clamp) compared to Groups II and III.
- TnT levels were significantly lower in Group III (beating-heart without CPB) compared to Group II (beating-heart on pump) at 48 hours post-operation.
Conclusions:
- Coronary bypass grafting performed without aortic cross-clamping and cardiopulmonary bypass (CPB) provides superior myocardial protection.
- This approach minimizes myocardial cell damage as indicated by lower TnT release.
Objective:
Troponin T is a unique marker which might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. The aim of the study was a comparison between intra-operative release of troponin T (TnT) during three different myocardial protection strategies.
Methods:
Thirty-eight PTS undergoing myocardial revascularization were randomised into 3 groups in whom procedure was performed with intermittent cross-clamp (Group I; n = 13), beating-heart on pump without aortic cross-clamp (Group II; n = 12), beating-heart without use of extracorporeal circulation (Group III; n = 13). Serial venous blood samples were collected for TnT measurement prior surgery, 1, 4, 12, 24, 48, 72 h after the procedure. Haemodynamic measurements were made using a thermodilution PA catheter.
Results:
The groups were similar with respect to age, sex, preoperative LV function, number of grafts, potential risk factors. There were no hospital deaths and no myocardial infarction (MI) in three groups, postoperative haemodynamic measurements showed no significant differences. TnT serum levels were significantly higher in group I when compared to groups II and III. TnT levels were significantly lower in group Ill when compared to group II following 48-h post-operation.
Conclusions:
Coronary bypass grafting without aortic cross-clamping and without CPB offers superior myocardial protection.