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Early Graft Reperfusion and Arrhythmias After Coronary Artery Bypass Grafting
Joona Keronen1, Tuomas Huttunen2, Ari Mennander3,1
1Cardiothoracic Surgery, Tampere University Heart Hospital, Tampere, FIN.
Insights
Early reperfusion of the left internal thoracic artery (LITA) graft before aortic declamping during coronary artery bypass grafting (CABG) significantly reduced post-operative arrhythmias. This technique facilitates gradual myocardial reperfusion and improves early rhythm control.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Thoracic Surgery
Background:
- Post-coronary artery bypass grafting (CABG) arrhythmia is often linked to abrupt, simultaneous reperfusion.
- Investigating strategies to mitigate arrhythmias following CABG is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the impact of early left internal thoracic artery (LITA) graft reperfusion before aortic declamping on post-CABG arrhythmias.
- To compare the incidence of early arrhythmias between patients with staged versus simultaneous graft reperfusion.
Main Methods:
- Retrospective analysis of 109 consecutive patients undergoing CABG.
- Comparison of 46 patients with LITA graft flow release before aortic declamping (study group) versus 63 controls with simultaneous reperfusion.
- Recording and analysis of early post-CABG arrhythmias, including atrial fibrillation and ventricular arrhythmias.
Main Results:
- Early arrhythmias occurred in 15.2% of the study group versus 33.3% in controls (p=0.033).
- The study group exhibited lower creatine kinase-myocardial band levels (p=0.004).
- Sinus rhythm was achieved in most patients before extubation in both groups.
Conclusions:
- Releasing LITA graft flow before aortic declamping enables gradual myocardial reperfusion.
- This simple maneuver may effectively ensure early rhythm control after CABG.
- Early staged reperfusion is a promising strategy to reduce post-CABG arrhythmias.
Abstract:
Background Arrhythmia after coronary artery bypass grafting (CABG) may occur immediately after the abrupt onset of reperfusion via all coronary bypass grafts simultaneously. We investigated whether early reperfusion of the left anterior descending coronary artery before weaning from cardiopulmonary bypass would decrease the frequency of early arrhythmias after CABG. We compared patients undergoing release of the left internal thoracic artery (LITA) graft flow before versus after aortic declamping during CABG. Methodology In total, 109 consecutive patients undergoing CABG were retrospectively analyzed. The heart rhythms after CABG of 46 patients with flow release from LITA before aortic declamping (study group) were compared with 63 patients with complete onset of reperfusion of all coronary bypass grafts simultaneously after aortic declamping (controls). Early arrhythmias were recorded and included atrial fibrillation, ventricular tachycardia, ventricular fibrillation, and arrhythmias necessitating temporary pacemaker support. Results Early arrhythmias occurred in seven out of 46 study group patients with the early release of LITA graft flow compared with 21 out of 63 controls (15.2% vs. 33.3%, p = 0.033). Creatine kinase-myocardial band levels were lower in the study group than in the controls (27.5 ± 58.4 vs. 33.0 ± 48.0, p = 0.004, respectively). Sinus rhythm was achieved in all but three patients before extubation including two in the study group and one in the controls. Conclusions The simple maneuver of releasing LITA graft flow before aortic declamping during CABG allows gradual reperfusion of the myocardium and may ensure early rhythm control.
