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.	穆军升, 周帆, 张健群, 等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析. 中国胸心血管外科临床杂志, 2011, 18(5): 464-465.
2.	柏本健, 魏维强, 解洪涛, 等. 体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较. 中国胸心血管外科临床杂志, 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.	赵铁夫, 王盛宇, 陈宏, 等. 体外循环下冠状动脉旁路移植术中应用罂粟碱灌注的疗效分析. 中国胸心血管外科临床杂志, 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. 儿童心肌损伤检测指标的研究进展及优选劣汰. 临床和实验医学杂志, 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, 府伟灵, 主编. 临床生物化学与检验. 第 4 版. 北京: 人民卫生出版社, 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, 刘永民, 何仁良, 等. 近端优先序贯技术在老年非体外冠状动脉循环旁路移植术中的应用. 中华胸心血管外科杂志, 2013, 29(6): 374-376.
22.	喻磊, 谷天祥, 师恩祎, 等. 不同循环方式对老年患者冠状动脉旁路移植术预后的影响. 中华外科杂志, 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, 刘铭月, 闫姝洁, 等. 成人心脏手术中应用国产心肌保护停跳液与进口HTK溶液心肌保护效果临床观察. 中国体外循环杂志, 2017, 15(4): 208-211.

1. 穆军升, 周帆, 张健群, 等. 80岁以上老年患者冠状动脉旁路移植术65例临床分析. 中国胸心血管外科临床杂志, 2011, 18(5): 464-465.
2. 柏本健, 魏维强, 解洪涛, 等. 体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较. 中国胸心血管外科临床杂志, 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. 赵铁夫, 王盛宇, 陈宏, 等. 体外循环下冠状动脉旁路移植术中应用罂粟碱灌注的疗效分析. 中国胸心血管外科临床杂志, 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. 儿童心肌损伤检测指标的研究进展及优选劣汰. 临床和实验医学杂志, 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, 府伟灵, 主编. 临床生物化学与检验. 第 4 版. 北京: 人民卫生出版社, 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, 刘永民, 何仁良, 等. 近端优先序贯技术在老年非体外冠状动脉循环旁路移植术中的应用. 中华胸心血管外科杂志, 2013, 29(6): 374-376.
22. 喻磊, 谷天祥, 师恩祎, 等. 不同循环方式对老年患者冠状动脉旁路移植术预后的影响. 中华外科杂志, 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, 刘铭月, 闫姝洁, 等. 成人心脏手术中应用国产心肌保护停跳液与进口HTK溶液心肌保护效果临床观察. 中国体外循环杂志, 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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