Abstract
Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation.
Highlights
Coronary artery disease (CAD) is the single largest cause of death in industrialized countries
Coronary artery bypass grafting (CABG) is associated with the reduction of mortality, and remains a standard therapy in patients with extensive CAD when compared with percutaneous coronary intervention (PCI) and pharmacological treatment alone [1]
A further effort in minimizing the occurrence of some complications related to conventional CABG has led to the development of off-pump coronary artery bypass (OPCAB), a technique in which the anastomoses are performed on the beating heart
Summary
Coronary artery disease (CAD) is the single largest cause of death in industrialized countries. There is compelling evidence for a link between microvascular dysfunction, coronary collateral development, and the pathogenesis of CAD. Coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) are both well-established revascularization methods to treat CAD. CABG is associated with the reduction of mortality, and remains a standard therapy in patients with extensive CAD when compared with PCI and pharmacological treatment alone [1]. A further effort in minimizing the occurrence of some complications related to conventional CABG has led to the development of off-pump coronary artery bypass (OPCAB), a technique in which the anastomoses are performed on the beating heart. Taken together, accumulating evidence suggests that OPCAB may significantly reduce the rate of mortality and morbidity when compared with conventional CABG [2]
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