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Myocardial injury during reoperation for coronary artery bypass surgery
1Department of Anesthesia, University of California, San Francisco, CA, USA.
Insights
Myocardial injury occurs more frequently during reoperation for coronary artery bypass surgery than previously thought. This study highlights intraoperative triggers and timing, especially before cardiopulmonary bypass (CPB).
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiology
Background:
- Reoperation for coronary artery bypass surgery (CABG) carries inherent risks.
- Myocardial injury incidence and triggers during reoperative CABG are not well-defined.
- Understanding these factors is crucial for patient safety and surgical outcomes.
Purpose of the Study:
- To determine the incidence of myocardial injury during reoperation for CABG.
- To identify triggers and timing of myocardial injury in this patient population.
- To compare intraoperative findings with previously reported data.
Main Methods:
- Prospective observational study conducted at a tertiary care university hospital.
- 15 patients undergoing reoperative CABG were monitored.
- Multilead electrocardiographic (ECG) monitoring every ~3 minutes; myocardial injury defined by peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L.
Main Results:
- Seven of 15 patients (47%) demonstrated myocardial injury, all intraoperatively.
- Five patients experienced new ST elevation episodes before cardiopulmonary bypass (CPB).
- Triggers included heart rate increase, surgical manipulation of the heart/old grafts, and protamine administration.
Conclusions:
- The intraoperative incidence of myocardial injury during reoperative CABG is substantially higher than previously reported.
- Myocardial injury, particularly before CPB, is a significant concern in reoperative CABG.
- Early identification of triggers can potentially mitigate perioperative myocardial injury.
Objectives:
To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery.
Design:
Prospective observational.
Setting:
One tertiary care university hospital.
Participants:
15 patients undergoing reoperation.
Interventions:
Multilead electrocardiographic monitoring approximately every 3 minutes during surgery.
Measurements And Main Results:
The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration.
Conclusions:
In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.