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On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury.
Eur J Cardiothorac Surg. 2005 Jun; 27(6):1057-64.EJ

Abstract

OBJECTIVE

By maintaining native coronary blood flow in on-pump beating heart surgery (OnP-BH) and comparing with OPCAB strategy pump-related effects on myocardial injury and cardiac dysfunction could be specifically differentiated from ischemia/reperfusion-related consequences of surgical coronary revascularization.

METHODS

In a randomized-prospective design, 40 elective patients with normal EF and three vessels coronary artery disease (left main disease excluded) were assigned to OPCAB or OnP-BH surgery. Before coronary occlusion and 1, 30, 60, and 90 min after reperfusion with the LIMA graft, coronary sinus (CS) blood was sampled to determine intraoperative myocardial ischemia (pH, lactate, pO2) and oxidative stress (malondialdehyde, MDA). Additionally to CS blood arterial blood was analyzed 4, 12, and 24 h postoperatively to determine myocardial necrosis (CK-MB, cardiac troponin I), myocardial dysfunction (NT-proBNP) and inflammation (C-reactive protein).

RESULTS

Groups were identical with regards to age and gender (OPCAB 63.0+/-6.0 versus OnP-BH 65.3+/-3.9 y, 20% female patients). Number of grafts were 3.0+/-0.5 in OPCAB versus 2.9+/-0.3 in OnP-BH (n.s.) with 44 versus 34% bilateral IMAs and 56 versus 50% complete arterial revascularization. Regarding ischemia, intraoperatively only lactate values increased significantly in the OnP-BH group. Significantly higher CK-MB and troponin I levels were found from LIMA-LAD flow release onwards to 4 h postoperatively in the OnP-BH group. NT-proBNP levels were significantly higher in the OnP-BH group during the entire study period. CRP levels were higher in the OnP-BH group 12 and 24 h postoperatively.

CONCLUSIONS

In this randomized study on routine coronary patients with normal ventricular function, OPCAB revealed less myocardial injury than OnP-BH. These findings implicate that CPB slightly affects the myocardium.

Authors+Show Affiliations

Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Struempellstr. 39, 04289 Leipzig, Germany. rastan@rz.uni-leipzig.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15896617

Citation

Rastan, Ardawan Julian, et al. "On-pump Beating Heart Versus Off-pump Coronary Artery Bypass Surgery-evidence of Pump-induced Myocardial Injury." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 27, no. 6, 2005, pp. 1057-64.
Rastan AJ, Bittner HB, Gummert JF, et al. On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg. 2005;27(6):1057-64.
Rastan, A. J., Bittner, H. B., Gummert, J. F., Walther, T., Schewick, C. V., Girdauskas, E., & Mohr, F. W. (2005). On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 27(6), 1057-64.
Rastan AJ, et al. On-pump Beating Heart Versus Off-pump Coronary Artery Bypass Surgery-evidence of Pump-induced Myocardial Injury. Eur J Cardiothorac Surg. 2005;27(6):1057-64. PubMed PMID: 15896617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. AU - Rastan,Ardawan Julian, AU - Bittner,Hartmuth Bruno, AU - Gummert,Jan Fritz, AU - Walther,Thomas, AU - Schewick,Claudia V, AU - Girdauskas,Evaldes, AU - Mohr,Friedrich Wilhelm, Y1 - 2005/04/08/ PY - 2004/11/29/received PY - 2005/02/27/revised PY - 2005/03/09/accepted PY - 2005/5/18/pubmed PY - 2005/10/12/medline PY - 2005/5/18/entrez SP - 1057 EP - 64 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 27 IS - 6 N2 - OBJECTIVE: By maintaining native coronary blood flow in on-pump beating heart surgery (OnP-BH) and comparing with OPCAB strategy pump-related effects on myocardial injury and cardiac dysfunction could be specifically differentiated from ischemia/reperfusion-related consequences of surgical coronary revascularization. METHODS: In a randomized-prospective design, 40 elective patients with normal EF and three vessels coronary artery disease (left main disease excluded) were assigned to OPCAB or OnP-BH surgery. Before coronary occlusion and 1, 30, 60, and 90 min after reperfusion with the LIMA graft, coronary sinus (CS) blood was sampled to determine intraoperative myocardial ischemia (pH, lactate, pO2) and oxidative stress (malondialdehyde, MDA). Additionally to CS blood arterial blood was analyzed 4, 12, and 24 h postoperatively to determine myocardial necrosis (CK-MB, cardiac troponin I), myocardial dysfunction (NT-proBNP) and inflammation (C-reactive protein). RESULTS: Groups were identical with regards to age and gender (OPCAB 63.0+/-6.0 versus OnP-BH 65.3+/-3.9 y, 20% female patients). Number of grafts were 3.0+/-0.5 in OPCAB versus 2.9+/-0.3 in OnP-BH (n.s.) with 44 versus 34% bilateral IMAs and 56 versus 50% complete arterial revascularization. Regarding ischemia, intraoperatively only lactate values increased significantly in the OnP-BH group. Significantly higher CK-MB and troponin I levels were found from LIMA-LAD flow release onwards to 4 h postoperatively in the OnP-BH group. NT-proBNP levels were significantly higher in the OnP-BH group during the entire study period. CRP levels were higher in the OnP-BH group 12 and 24 h postoperatively. CONCLUSIONS: In this randomized study on routine coronary patients with normal ventricular function, OPCAB revealed less myocardial injury than OnP-BH. These findings implicate that CPB slightly affects the myocardium. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/15896617/On_pump_beating_heart_versus_off_pump_coronary_artery_bypass_surgery_evidence_of_pump_induced_myocardial_injury_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2005.03.007 DB - PRIME DP - Unbound Medicine ER -