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Updated: Sep 1, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Graft preservation confers myocardial protection during coronary artery bypass grafting
Philipp Szalkiewicz1, Maximilian Y Emmert2,3, Paul P Heinisch4
1Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria.
Insights
DuraGraft (DG) significantly reduced post-surgery high-sensitive Troponin I (hs-TnI) levels compared to Saline/Biseko (SB) during coronary artery bypass grafting. This suggests DG offers enhanced myocardial protection in patients undergoing ONCAB.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- On-pump coronary artery bypass grafting (ONCAB) involves graft flushing, which perfuses downstream myocardium.
- Evaluating preservation solutions for myocardial protection during ONCAB is crucial.
Purpose of the Study:
- To assess the impact of DuraGraft (DG) versus 0.9% Saline/Biseko (SB) on myocardial protection during ONCAB.
Main Methods:
- A single-center retrospective study involving 272 ONCAB patients between July 2019 and March 2020.
- 166 patients were propensity-matched into DG and SB groups.
- Post-operative cardiac enzymes (hs-TnI and CK) were monitored for 7 days.
Main Results:
- The DG group showed significantly lower hs-TnI values from 3-6 hours up to 4 days post-surgery compared to the SB group.
- Maximum hs-TnI values and AUC were significantly lower in the DG group.
- No significant difference in creatine kinase (CK) values was observed between the groups.
Conclusions:
- Repeated graft flushing with DG appears to provide enhanced myocardial protection compared to SB, indicated by lower Troponin levels.
- Further research is needed to fully elucidate the myocardial protective properties of DG.
Background:
During on-pump coronary artery bypass grafting (ONCAB), graft flushing for distal anastomoses testing also perfuses the downstream myocardium. This single-center retrospective study evaluated the impact of specific preservation solutions on myocardial protection during ONCAB.
Materials And Methods:
Between July 2019 and March 2020 either DuraGraft (DG) or 0.9% Saline/Biseko (SB) was applied to 272 ONCAB. Overall, 166 patients were propensity-matched into two groups. Cardiac enzymes [high-sensitive Troponin I (hs-TnI) and creatine kinase (CK)] were evaluated 7 days post-surgery.
Results:
Post-surgery, hs-TnI values were significantly lower from 3 to 6 h (h) up to 4 days in the DG group: 3-6 h: 4,034 ng/L [IQR 1,853-8,654] vs. 5,532 ng/L [IQR 3,633-8,862], p = 0.05; 12-24 h: 2,420 ng/L [IQR 1,408-5,782] vs. 4,166 [IQR 2,052-8,624], p < 0.01; 2 days: 1,095 ng/L [IQR 479-2,311] vs. 1,564 ng/L [IQR 659-5,057], p = 0.02 and at 4 days: 488 ng/L [IQR 232-1,061] vs. 745 ng/L [IQR 319-1,820], p = 0.03. The maximum value: 4,151 ng/L [IQR 2,056-8,621] vs. 6,349 ng/L [IQR 4,061-12,664], p < 0.01 and the median area under the curve (AUC): 6,146 ng/L/24 h [IQR 3,121-13,248] vs. 10,735 ng/L/24 h [IQR 4,859-21,484], p = 0.02 were lower in the DG group. CK values were not significantly different between groups: maximum value 690 [IQR 417-947] vs. 631 [464-979], p = 0.61 and AUC 1,986 [1,226-2,899] vs. 2,081 [1,311-3,063], p = 0.37.
Conclusion:
Repeated graft flushing with DG resulted in lower Troponin values post-surgery suggesting enhanced myocardial protection compared to SB. Additional studies are warranted to further assess the myocardial protection properties of DG.
