Abstract
BackgroundCoronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. The aim of this study was to investigate whether a modified mechanical post-conditioning (MMPOC) technique has a myocardial protective effect by enhancing early metabolic recovery of the heart following revascularization.MethodsA prospective, randomized trial was conducted at a single-center university hospital performing adult cardiac surgery. Seventy-nine adult patients undergoing first-time elective isolated multivessel coronary artery bypass grafting were prospectively randomized to MMPOC or control group. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The post reperfusion cardiac indices, inotrope use and biochemical-electrocardiographic evidence of myocardial injury were recorded. The incidence of postoperative complications was recorded prospectively.ResultsOperative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups (p>0.05). The MMPOC group had lower troponin I and other cardiac biomarkers level post CPB and postoperatively, with greater improvement in cardiac indices (p<0.001). MMPOC shortened post surgery hospitalization from 9.1 ± 2.1 to 7.5 ± 1.6 days (p<0.001).ConclusionsMMPOC technique promotes early metabolic recovery of the heart during elective CABG, leading to better myocardial protection and functional recovery.
Highlights
Coronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury
The term post conditioning refers to the phenomenon in which multiple brief periods of reperfusion interspersed with brief periods of ischemia (10–60 s) result in a reduction in infarct size [3,4]
creatine kinase (CK) and Creatine kinase isoenzyme (CK-MB) remained lower in the study group from the 6th and 12th post-conditioning hours till the end of the study respectively in the modified mechanical post-conditioning (MMPOC) group (p
Summary
Coronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. Three cycles of ischemia/reperfusion are required to produce a maximal POC effect, four and six cycles have been shown to be effective by some investigators [3,4]. It is the interval of reperfusion and ischemia that is the most critical factor in determining how efficacious POC will be. POC protocols shown to be maximally effective at reducing infarct size range from 10 to 60 s depending on the specific species being studied [3,4]
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