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"Polarizing" microplegia improves cardiac cycle efficiency after CABG for unstable angina

Francesco Onorati1, Francesco Santini, Rajesh Dandale

  • 1Division of Cardiac Surgery, University of Verona Medical School, Italy. frankono@libero.it

International Journal of Cardiology
|July 17, 2012
PubMed

Insights

Microplegia (Mic) significantly reduces myocardial damage and improves heart function in unstable angina (UA) patients undergoing coronary artery bypass grafting (CABG). This myocardial protection strategy also leads to fewer transfusions and shorter hospital stays.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardioprotection

Background:

  • Myocardial protection during coronary artery bypass grafting (CABG) for unstable angina (UA) presents a significant challenge due to ischemia/reperfusion injury risks.
  • Limited research exists on the biochemical, hemodynamic, and echocardiographic outcomes of microplegia (Mic) in UA patients undergoing CABG.

Purpose of the Study:

  • To evaluate the efficacy of microplegia (Mic) compared to standard Buckberg-cardioplegia in protecting the myocardium during CABG for UA.
  • To assess the biochemical, hemodynamic, and echocardiographic effects of Mic in UA patients undergoing CABG.

Main Methods:

  • Eighty UA patients undergoing CABG were randomized to receive either Mic (Mic-Group) or standard 4:1 blood Buckberg-cardioplegia (Buck-Group).
  • Biochemical markers (Troponin-I, lactate), hemodynamic parameters (Cardiac Index, vascular resistances, Δp/Δt, cardiac cycle efficiency, CVP), and echocardiographic indices of systolic (WMSI) and diastolic function (E/A, Ea, E/Ea) were measured.
  • Measurements were taken preoperatively, at reperfusion, and at various time points postoperatively up to 96 hours.

Main Results:

  • The Mic-Group demonstrated significantly lower Troponin-I and lactate levels postoperatively compared to the Buck-Group (p=.001 and p=.0001, respectively).
  • Microplegia improved Wall Motion Score Index (WMSI) (time-p=.001) and resulted in higher Cardiac Index, Δp/Δt, and Cardiac Cycle Efficiency (CCE) (p=.0001).
  • Diastolic function (E, E/A, Ea) improved significantly better in the Mic-Group (p=.003, .001, .013). Mic also led to reduced transfusions (p=.006), hospitalization (p=.002), and ICU stay (p=.015).

Conclusions:

  • Microplegia is effective in attenuating myocardial damage in UA patients undergoing CABG.
  • Mic improves postoperative systolic and diastolic cardiac function and reduces the need for transfusions and length of hospitalization.
  • Microplegia represents a superior myocardial protection strategy for UA patients undergoing CABG.
Abstract

Keywords:
Coronary artery bypass graftingMicroplegiaMyocardial protectionUnstable angina

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