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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Coronary surgery: which method to use?
Miguel Sousa Uva1, Vanessa Rodrigues, Nuno Monteiro
1Departamento da Circulação Hospital da Cruz Vermelha, Lisboa. uvamiguel@hotmail.com
Insights
Comparing four coronary artery bypass grafting (CABG) methods, this study found no significant differences in mortality or morbidity. However, off-pump, beating heart, and cardioplegia methods offered better myocardial protection than ventricular fibrillation during CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Myocardial protection strategies during CABG significantly influence patient outcomes.
- Comparing different myocardial protection techniques is crucial for optimizing surgical results.
Purpose of the Study:
- To compare four myocardial protection methods during CABG: off-pump (OFF), cardiopulmonary bypass with cardioplegia (CARD), cardiopulmonary bypass with beating heart (BEAT), and cardiopulmonary bypass with ventricular fibrillation (FIBR).
- To evaluate these methods based on markers of myocardial ischemia, mortality, morbidity, and mid-term results.
Main Methods:
- A retrospective study of 241 patients undergoing isolated CABG.
- Patients were divided into four groups based on the myocardial protection method used: OFF (n=108), CARD (n=66), BEAT (n=47), and FIBR (n=20).
- Myocardial ischemia was assessed by measuring CK-MB and troponin T levels preoperatively and at 1, 6, 12, and 24 hours postoperatively.
Main Results:
- No significant differences were found in in-hospital mortality (2.5%), atrial fibrillation, stroke/TIA, blood transfusion rates, or length of stay between the groups.
- The number of distal anastomoses was highest in the BEAT group (3.27) and lowest in the OFF group (2.55).
- Myocardial markers (CK-MB and troponin T) were significantly higher in the FIBR group at 12 and 24 hours postoperatively compared to CARD and OFF groups, indicating less myocardial protection.
Conclusions:
- None of the four revascularization methods demonstrated superiority in terms of mortality, morbidity, or length of stay.
- Off-pump, beating heart, and cardioplegia methods provided better myocardial protection compared to ventricular fibrillation, as evidenced by lower myocardial ischemia markers.
- Mid-term survival and angina relief were comparable across all studied groups.
Objective:
To compare 4 methods of myocardial protection in GABG in terms of markers of myocardial ischemia, mortality, morbidity and mid-term results.
Material & Methods:
Retrospective study of 241 consecutive patients undergoing isolated > 1 CABG using one of 4 methods: off-pump (OFF, n = 108), cardiopulmonary bypass (CPB) and cardioplegia (CARD, n = 66), CPB and beating heart (BEAT, n = 47), or CPB and ventricular fibrillation (FIBR, n = 20). Mean age was 65.7 +/- 9.3 years and mean EuroSCORE was 3.2 +/- 2.3. The groups were similar in terms of age, gender distribution, body mass index, incidence of smoking, hypertension, renal insufficiency, CCS class, ventricular function and mean EuroSCORE. Serial blood samples were collected for CK-MB and troponin T, preoperatively and 1, 6, 12 and 24 hours after the procedure.
Results:
Mean number of distal anastomoses was 3.27 BEAT, 2.98 CARD, 2.90 FIBR and 2.55 OFF (p < 0.05 OFF vs. the other 3 groups). Six patients died in hospital (2.5%), 2/47 BEAT (4.2%), 1/66 CARD (1.5%), 1/20 FIBR (5.0%), 2/108 (1.9% OFF) (p = 0.1). The incidence of atrial fibrillation, stroke/TIA and blood transfusion and length of stay were similar between groups (p = 0.1) but there was a tendency for increased incidence of Q-wave MI (p = 0.08) in OFF and combined adverse events in FIBR (p = 0.07). At 12 hours postoperatively, CK-MB and troponin T were significantly higher in FIBR than in CARD or OFF (p < 0.05) and at 24 hours, troponin T remained higher in FIBR than in all other groups (p < 0.05). After a mean follow-up of 19 months, no significant difference was observed between groups in mortality or relief of angina.
Conclusion:
We were unable to demonstrate the superiority of any one revascularization method over another in terms of mortality, morbidity or length of stay. As shown by lower levels of myocardial markers of ischemia, better myocardial protection was obtained with OFF, BEAT and CARD compared to FIBR. Mid-term survival and relief of angina were similar between groups.
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