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Published on: September 15, 2023
Coronary artery bypass grafting on beating heart. Does it provide superior myocardial preservation than conventional
Anjum Jalal1, Aftab Yunus, Ahmed Mn Abualazm
1Division of Cardiac Surgery, King Khalid University Hospital, Riyadh 11472, Kingdom of Saudi Arabia. anjumjalal1@hotmail.com
Insights
The off-pump coronary artery bypass grafting (CABG) technique shows better myocardial preservation compared to conventional and on-pump beating-heart methods. This finding suggests improved outcomes for patients undergoing off-pump CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
- Myocardial Protection
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Different CABG techniques exist, including conventional, off-pump, and on-pump beating-heart methods.
- Assessing myocardial injury associated with these techniques is crucial for patient outcomes.
Purpose of the Study:
- To compare the extent of myocardial injury resulting from three common coronary artery bypass grafting (CABG) techniques.
- To evaluate the impact of conventional, off-pump, and on-pump beating-heart CABG on myocardial damage.
Main Methods:
- A prospective randomized study involving 45 patients undergoing CABG.
- Patients were divided into three groups: conventional CABG, off-pump CABG, and on-pump beating-heart CABG.
- Creatine kinase, myocardial band (CKMB) levels were measured at multiple time points post-surgery to assess myocardial injury.
Main Results:
- Pre-operative characteristics were similar across all three groups.
- While intensive care unit stay and inotrope duration were shortest in the off-pump group, the difference was not statistically significant.
- Significantly higher creatine kinase, myocardial band (CKMB) levels were observed in the conventional CABG group compared to the other two techniques.
Conclusions:
- The off-pump CABG technique demonstrates superior myocardial preservation compared to conventional and on-pump beating-heart methods.
- This suggests that off-pump CABG may be a preferable surgical option for minimizing myocardial injury.
Objective:
To compare myocardial injury caused by 3 commonly used methods for coronary artery bypass grafting (CABG).
Methods:
A prospective randomized study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. The study started in February 2003 and concluded in April 2004 after including 45 patients (15 patients in each of 3 sub-groups) who fulfilled the inclusion and exclusion criteria. The subgroups included coronary artery bypass surgery performed by: a) conventional technique, b) off-pump technique, and c) on-pump beating-heart techniques. All patients had similar operative risk profiles. Their ages were 70 years or less with an ejection fraction of 30-50%. The creatine kinase, myocardial band (CKMB) levels were determined 2 hours after arrival from the operating room then, at 4 hours, 6 hours, and 12 hours. The comparison of creatine phosphokinase and CKMB levels was carried out using analysis of variance with repeated measures. The p-values were used to evaluate the significance of differences.
Results:
The pre-operative characteristics including age, gender, ethnic origin, diabetes mellitus, hypertension, and left ventricular function, were similar in the 3 groups. All groups had a median number of 3 bypass grafts. The stay in the intensive care unit and the duration of inotropes were shortest in the off-pump group, but the difference was not significant. There was a peak of CKMB levels at 6 hours in all groups. The trend of CKMB level showed significantly higher values in the conventional CABG group as compared with the other 2 groups.
Conclusion:
This study indicates that the off-pump technique provides better myocardial preservation than other methods.
