Effect on myocardial injury between off-pump and modified perfusion on-pump coronary artery bypass grafting: A retrospective cohort study in 558 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHAO Tiefu , WANG Shengyu , ZHANG Chunxiao , ZHANG Ming , ZENG Wen , WANG Jiangang , ZHENG Shuai , CHEN Hong

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding?author：

ZHAO Tiefu, Email: tiefuzhao@163.com

Keywords：

On-pump coronary artery bypass grafting; off-pump coronary artery bypass grafting; myocardial injury; surgery

DOI：

10.7507/1007-4848.202003011

Video：

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Objective To explore the difference of myocardial injury between off-pump coronary artery bypass grafting (OPCAB) and modified perfusion on-pump coronary artery bypass grafting (ONCAB).Methods A total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included. According to whether or not they received modified perfusion cardiopulmonary bypass, all the 558 patients were divided into two groups including an OPCAB group (OP group) and an ONCAB group (ON group). There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years. In the ON group, there were 93 patients including 64 males and 29 females with an average age of 63.91±7.51 years. Creatine kinase MB (CK-MB) and cardiac specific troponin I (cTnI) were measured 24 hours before operation, 30 minutes after operation, 12 hours after operation, 36 hours after operation and 48 hours after operation.Results No perioperative death occurred in all patients. CK-MB (5.00 ng/mL vs. 8.60 ng/mL, Z=–2.189, P=0.029) and cTnI (3.00 ng/mL vs. 7.80 ng/mL, Z=–5.307, P=0.000) in postoperative 12 hours in the ON group were less than those in the OP group. CK-MB (5.00 ng/mL vs. 5.60 ng/mL, Z=–2.280, P=0.023) and cTnI (0.10 ng/mL vs. 1.02 ng/mL, Z=–6.418, P=0.000) in postoperative 36 hours in the ON group were less than those in the OP group. cTnI (0.07 ng/mL vs. 0.81 ng/mL, Z=–1.946, P=0.032) in postoperative 48 hours in the ON group was less than that in the OP group.Conclusion Compared with OPCAB, modified perfusion ONCAB has less myocardial damage.

Citation： ZHAO Tiefu, WANG Shengyu, ZHANG Chunxiao, ZHANG Ming, ZENG Wen, WANG Jiangang, ZHENG Shuai, CHEN Hong. Effect on myocardial injury between off-pump and modified perfusion on-pump coronary artery bypass grafting: A retrospective cohort study in 558 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 81-86. doi: 10.7507/1007-4848.202003011 Copy

1.	穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 464-465.
2.	柏本健, 魏維強, 解洪濤, 等. 體外循環和非體外循環冠狀動脈旁路移植術的早期療效比較. 中國胸心血管外科臨床雜志, 2010, 17(3): 244-246.
3.	Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
4.	Shaefi S, Mittel A, Loberman D, et al. Off-pump versus on-pump coronary artery bypass grafting —A systematic review and analysis of clinical outcomes. J Cardiothor Vasc AN, 2019, 33(1): 232-244.
5.	Diegeler A, Borgermann J, Kappert U, et al. OPCAB versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
6.	Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
7.	Hausenloy DJ, Boston-Griffiths E, Yellon DM. Cardioprotection during cardiac surgery. Cardiovasc Res, 2012, 94(2): 253-265.
8.	Ji Q, Mei Y, Wang X, et al. On-pump versus off-pump coronary bypass surgery in high-risk patients. Int Heart J, 2014, 55(6): 484-488.
9.	Godinho AS, Alves AS, Pereira AJ, et al. On-pump versus off-pump coronary bypass surgery: A meta-analysis. Arq Bras Cardiol, 2012, 8(1): 987-94.
10.	Lemma MG, Coscioni E, Tritto FP, et al. On-pump versus off-pump coronary bypass surgery in high-risk patients: operative results of a prospective randomized trial (on-off study). J Thorac Cardiovasc Surg, 2012, 143(3): 625-631.
11.	Keshavamurthy S, Blackstone EH, Pettersson GB. Comment on: Retrograde cardioplegia revisited: open technique for long aortic cross clamping. Heart Lung Circ, 2014, 23(6): 589.
12.	Yavuz S, Kasap M, Parlar H, et al. Heat shock proteins and myocardial protection during cardiopulmonary bypass. J Int Med Res, 2011, 39(2): 499-507.
13.	趙鐵夫, 王盛宇, 陳宏, 等. 體外循環下冠狀動脈旁路移植術中應用罌粟堿灌注的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(12): 1150-1153.
14.	Eggers KM, Lindahl B. Application of cardiac troponin in cardiovascular diseases other than acute coronary syndrome. Clin Chem, 2017, 63(1): 223-235.
15.	侯安存. 兒童心肌損傷檢測指標的研究進展及優選劣汰. 臨床和實驗醫學雜志, 2015, 14(20): 1750-1753.
16.	Boeddinghaus J, Twerenbold R, Nestelberger T, et al. Clinical validation of a novel high - sensitivity cardiac troponin I assay for early diagnosis of acute myocardial infarction. Clin Chem, 2018, 64(9): 1347-1360.
17.	周新, 府偉靈, 主編. 臨床生物化學與檢驗. 第 4 版. 北京: 人民衛生出版社, 2004. 335.
18.	Machler H, Metzler H, Sabin K, et al. Preoperative myocardial cell damage in patients with unstable angina undergoing coronary artery bypass graft surgery. Anesthesiology, 1994, 81(6): 1324-1331.
19.	Mair P, Mair J, Seibt I, et al. Cardiac troponin T: A new marker of myocardial tissue damage in bypass surgery. J Cardiaothorac Vase Anesth, 1993, 7(6): 674-678.
20.	Gu CX, Yang JF, Zhang HC, et al. Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft. J Geriatr Cardiol, 2012, 9(3): 247-251.
21.	夏瑜, 劉永民, 何仁良, 等. 近端優先序貫技術在老年非體外冠狀動脈循環旁路移植術中的應用. 中華胸心血管外科雜志, 2013, 29(6): 374-376.
22.	喻磊, 谷天祥, 師恩祎, 等. 不同循環方式對老年患者冠狀動脈旁路移植術預后的影響. 中華外科雜志, 2010, 48(9): 694-696.
23.	Chaturvedi RR, Lincoln C, Gothard JW, et al. Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: quantitation with the use of a conductance catheter immediately after bypass. J Thorac Cardiovasc Surg, 1998, 115(1): 77-83.
24.	李勇男, 劉銘月, 閆姝潔, 等. 成人心臟手術中應用國產心肌保護停跳液與進口HTK溶液心肌保護效果臨床觀察. 中國體外循環雜志, 2017, 15(4): 208-211.

1. 穆軍升, 周帆, 張健群, 等. 80歲以上老年患者冠狀動脈旁路移植術65例臨床分析. 中國胸心血管外科臨床雜志, 2011, 18(5): 464-465.
2. 柏本健, 魏維強, 解洪濤, 等. 體外循環和非體外循環冠狀動脈旁路移植術的早期療效比較. 中國胸心血管外科臨床雜志, 2010, 17(3): 244-246.
3. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol, 2002, 40(7): 1366-1374.
4. Shaefi S, Mittel A, Loberman D, et al. Off-pump versus on-pump coronary artery bypass grafting —A systematic review and analysis of clinical outcomes. J Cardiothor Vasc AN, 2019, 33(1): 232-244.
5. Diegeler A, Borgermann J, Kappert U, et al. OPCAB versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med, 2013, 368(13): 1189-1198.
6. Sarin EL, Kayatta MO, Kilgo P, et al. Short-and long-term outcomes in octogenarian patients undergoing OPCAB coronary artery bypass grafting compared with on-pump coronary artery bypass grafting. Innovations (Phila), 2011, 6(2): 110-115.
7. Hausenloy DJ, Boston-Griffiths E, Yellon DM. Cardioprotection during cardiac surgery. Cardiovasc Res, 2012, 94(2): 253-265.
8. Ji Q, Mei Y, Wang X, et al. On-pump versus off-pump coronary bypass surgery in high-risk patients. Int Heart J, 2014, 55(6): 484-488.
9. Godinho AS, Alves AS, Pereira AJ, et al. On-pump versus off-pump coronary bypass surgery: A meta-analysis. Arq Bras Cardiol, 2012, 8(1): 987-94.
10. Lemma MG, Coscioni E, Tritto FP, et al. On-pump versus off-pump coronary bypass surgery in high-risk patients: operative results of a prospective randomized trial (on-off study). J Thorac Cardiovasc Surg, 2012, 143(3): 625-631.
11. Keshavamurthy S, Blackstone EH, Pettersson GB. Comment on: Retrograde cardioplegia revisited: open technique for long aortic cross clamping. Heart Lung Circ, 2014, 23(6): 589.
12. Yavuz S, Kasap M, Parlar H, et al. Heat shock proteins and myocardial protection during cardiopulmonary bypass. J Int Med Res, 2011, 39(2): 499-507.
13. 趙鐵夫, 王盛宇, 陳宏, 等. 體外循環下冠狀動脈旁路移植術中應用罌粟堿灌注的療效分析. 中國胸心血管外科臨床雜志, 2016, 23(12): 1150-1153.
14. Eggers KM, Lindahl B. Application of cardiac troponin in cardiovascular diseases other than acute coronary syndrome. Clin Chem, 2017, 63(1): 223-235.
15. 侯安存. 兒童心肌損傷檢測指標的研究進展及優選劣汰. 臨床和實驗醫學雜志, 2015, 14(20): 1750-1753.
16. Boeddinghaus J, Twerenbold R, Nestelberger T, et al. Clinical validation of a novel high - sensitivity cardiac troponin I assay for early diagnosis of acute myocardial infarction. Clin Chem, 2018, 64(9): 1347-1360.
17. 周新, 府偉靈, 主編. 臨床生物化學與檢驗. 第 4 版. 北京: 人民衛生出版社, 2004. 335.
18. Machler H, Metzler H, Sabin K, et al. Preoperative myocardial cell damage in patients with unstable angina undergoing coronary artery bypass graft surgery. Anesthesiology, 1994, 81(6): 1324-1331.
19. Mair P, Mair J, Seibt I, et al. Cardiac troponin T: A new marker of myocardial tissue damage in bypass surgery. J Cardiaothorac Vase Anesth, 1993, 7(6): 674-678.
20. Gu CX, Yang JF, Zhang HC, et al. Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft. J Geriatr Cardiol, 2012, 9(3): 247-251.
21. 夏瑜, 劉永民, 何仁良, 等. 近端優先序貫技術在老年非體外冠狀動脈循環旁路移植術中的應用. 中華胸心血管外科雜志, 2013, 29(6): 374-376.
22. 喻磊, 谷天祥, 師恩祎, 等. 不同循環方式對老年患者冠狀動脈旁路移植術預后的影響. 中華外科雜志, 2010, 48(9): 694-696.
23. Chaturvedi RR, Lincoln C, Gothard JW, et al. Left ventricular dysfunction after open repair of simple congenital heart defects in infants and children: quantitation with the use of a conductance catheter immediately after bypass. J Thorac Cardiovasc Surg, 1998, 115(1): 77-83.
24. 李勇男, 劉銘月, 閆姝潔, 等. 成人心臟手術中應用國產心肌保護停跳液與進口HTK溶液心肌保護效果臨床觀察. 中國體外循環雜志, 2017, 15(4): 208-211.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect on myocardial injury between off-pump and modified perfusion on-pump coronary artery bypass grafting: A retrospective cohort study in 558 patients

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