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Published on: March 27, 2018
Myocardial preservation during coronary surgery with and without cardiopulmonary bypass
H J Penttilä1, M V Lepojärvi, K T Kiviluoma
1Department of Anesthesiology, Oulu University Hospital, Finland. hannu.penttila@oulu.fi
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) shows improved myocardial energy preservation and reduced cardiac damage compared to traditional CABG with CPB. This suggests beating heart surgery offers better outcomes for heart muscle health.
Area of Science:
- Cardiovascular Surgery
- Cardiac Metabolism
- Myocardial Protection
Background:
- Growing interest in Coronary Artery Bypass Grafting (CABG) without cardiopulmonary bypass (CPB).
- Limited investigation into myocardial preservation during off-pump CABG.
- Need to compare myocardial metabolism in on-pump vs. off-pump CABG.
Purpose of the Study:
- To compare myocardial energy metabolism and tissue injury during CABG with and without CPB.
- To evaluate the impact of CPB on myocardial metabolic changes.
- To assess markers of myocardial damage in both surgical approaches.
Main Methods:
- Randomized study involving 22 patients undergoing CABG.
- 11 patients underwent CABG with CPB.
- 11 patients underwent CABG without CPB (beating heart surgery).
- Monitoring of myocardial energy metabolism and tissue injury markers.
Main Results:
- Significantly higher myocardial lactate production in the CPB group (0.56 mmol/L) vs. off-CPB (0.17 mmol/L).
- Greater transcardiac pH differences observed with CPB (0.085 vs. 0.034).
- Elevated postoperative creatine kinase-MB mass and troponin I levels in the CPB group.
Conclusions:
- Off-pump CABG (beating heart surgery) demonstrates superior myocardial energy preservation.
- Conventional CABG with CPB is associated with increased myocardial damage.
- Beating heart surgery offers better myocardial protection compared to CPB with cardioplegia.
Background:
There is increased interest in coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), although the preservation of the myocardium under such circumstances has not been properly investigated. The aim of this randomized study was to compare the changes in myocardial metabolism during CABG with and without CPB.
Methods:
Myocardial energy metabolism and tissue injury during CABG was monitored in a series of 22 patients (11 with and 11 without CPB).
Results:
The maximum myocardial lactate production was significantly higher (p = 0.02) in the group operated with CPB (0.56 mmol/L) than without it (0.17 mmol/L). A similar phenomenon was seen in the transcardiac pH differences (0.085 and 0.034 with and without CPB, p = 0.007). The postoperative peak values of creatine kinase-MB mass (15.1 vs 6.3 microg/L) and troponin I (13.8 vs 5.2 microg/L) were significantly higher (p < 0.001 and p = 0.008) with than without CPB.
Conclusions:
CABG on a beating heart is associated with better myocardial energy preservation and less myocardial damage compared with conventional CABG with CPB and intermittent antegrade mild hypothermic blood cardioplegia.
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