Off-pump coronary bypass grafting is associated with less myocardial injury than coronary bypass surgery with cardiopulmonary bypass
Background: Excessive myocardial necrosis following coronary artery bypass grafting is associated with adverse outcome. The present study was designed to assess the extent of myocardial injury after conventional coronary artery bypass grafting with cardiopulmonary bypass (ONCAB) compared with off-pump coronary artery bypass (OPCAB). Methods: Measurements of serum cardiac troponin T (TnT) were obtained in 137 consecutive, unselected patients who underwent coronary artery bypass grafting. Serial blood sampling was performed at 3 time intervals after surgery: immediately postoperatively, 6 to 12 hours postoperatively, and 18 to 24 hours postoperatively. Results: ONCAB patients totaled 122, and OPCAB patients numbered 15. Ten patients in the ONCAB group suffered perioperative complications, compared with no patients in the OPCAB group. At each time point examined, OPCAB patients exhibited significantly less release of TnT than ONCAB patients (immediately postoperative TnT, 1.99 ± 4.75 ng/mL versus 0.20 ± 0.32 ng/mL, P = .004; 6- to 12-hour ThT, 2.28 ± 3.66 ng/mL versus 0.37 ± 0.32 ng/mL, P = .001; and 18- to 24-hour TnT 1.59 ± 3.49 ng/mL versus 0.30 ± 0.32 ng/mL, P = .01). When ONCAB patients with perioperative ischemic complications were excluded, the differences between the 2 groups remained. The OPCAB patients still demonstrated less TnT release, typically 5- to 6-fold less than for ONCAB patients. Conclusions: The nearly 6-fold reduction of postoperative TnT associated with OPCAB suggests that off-pump surgery may offer superior cardioprotection than coronary artery bypass grafting with conventional cardiopulmonary bypass.
Kathiresan, S; MacGillivray, TE; Lewandrowski, K; Servoss, SJ; Lewandrowski, E; Januzzi, JL
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