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Ardawan Julian Rastan
Hartmuth Bruno Bittner
Jan Fritz Gummert
Thomas Walther
Friedrich Wilhelm Mohr
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Eur J Cardiothorac Surg 2005;27:1057-1064
© 2005 Elsevier Science NL

On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury

Ardawan Julian Rastan*, Hartmuth Bruno Bittner, Jan Fritz Gummert, Thomas Walther, Claudia V. Schewick, Evaldes Girdauskas, Friedrich Wilhelm Mohr

Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Struempellstr. 39, 04289 Leipzig, Germany

Received 29 November 2004; received in revised form 27 February 2005; accepted 9 March 2005.

* Corresponding author. Tel.: +49 341/8651421; fax: +49 341/8696646. (E-mail: rastan{at}rz.uni-leipzig.de).

Objective: By maintaining native coronary blood flow in on-pump beating heart surgery (OnP-BH) and comparing with OPCAB strategy pump-related effects on myocardial injury and cardiac dysfunction could be specifically differentiated from ischemia/reperfusion-related consequences of surgical coronary revascularization. Methods: In a randomized-prospective design, 40 elective patients with normal EF and three vessels coronary artery disease (left main disease excluded) were assigned to OPCAB or OnP-BH surgery. Before coronary occlusion and 1, 30, 60, and 90min after reperfusion with the LIMA graft, coronary sinus (CS) blood was sampled to determine intraoperative myocardial ischemia (pH, lactate, pO2) and oxidative stress (malondialdehyde, MDA). Additionally to CS blood arterial blood was analyzed 4, 12, and 24h postoperatively to determine myocardial necrosis (CK-MB, cardiac troponin I), myocardial dysfunction (NT-proBNP) and inflammation (C-reactive protein). Results: Groups were identical with regards to age and gender (OPCAB 63.0±6.0 versus OnP-BH 65.3±3.9 y, 20% female patients). Number of grafts were 3.0±0.5 in OPCAB versus 2.9±0.3 in OnP-BH (n.s.) with 44 versus 34% bilateral IMAs and 56 versus 50% complete arterial revascularization. Regarding ischemia, intraoperatively only lactate values increased significantly in the OnP-BH group. Significantly higher CK-MB and troponin I levels were found from LIMA-LAD flow release onwards to 4h postoperatively in the OnP-BH group. NT-proBNP levels were significantly higher in the OnP-BH group during the entire study period. CRP levels were higher in the OnP-BH group 12 and 24h postoperatively. Conclusions: In this randomized study on routine coronary patients with normal ventricular function, OPCAB revealed less myocardial injury than OnP-BH. These findings implicate that CPB slightly affects the myocardium.

Key Words: Cardioplulmonary bypass • OPCAB • Beating heart surgery • Myocardial injury • Biomarkers




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