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Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study

Marek Pojar^a,_*, Jií Mand’ák^a, Norbert Cibíek^b, Vladimír Lonsk^a, Jan Dominik^a, Vladimír Palika^b, Jaroslav Kubíek^a

^a Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, 50005 Hradec Králové, Czech Republic
^b Institute of Clinical Biochemistry and Diagnostics, Charles University in Prague, Faculty of Medicine and University Hospital, 50005 Hradec Králové, Czech Republic

Received 14 September 2007; received in revised form 15 January 2008; accepted 24 January 2008.

^_* Corresponding author. Tel.: +420 49 5833603; fax: +420 49 5833026. (Email: marek.pojar{at}centrum.cz).

Objective: The aim of this study was to monitor and compare metabolic changes in the skeletal muscle during coronary artery bypass grafting surgery with and without cardiopulmonary bypass (CPB) by means of interstitial microdialysis. Glucose, lactate, pyruvate and glycerol were assessed as markers of basic metabolism and tissue perfusion. Methods: Twenty patients undergoing surgical myocardial revascularization were enrolled in this pilot study. Ten patients were operated on without CPB (group A, off-pump) and 10 patients using normothermic CPB (group B, on-pump). Interstitial microdialysis was performed by a CMA 60 (CMA/Microdialysis AB, Sweden) probe, inserted into the patient's left deltoid muscle. Microdialysis measurements were performed at 30 min intervals. Glucose, lactate, pyruvate and glycerol were measured in samples using a CMA 600 Analyser (CMA/Microdialysis AB, Sweden). Results in both groups were statistically processed and the groups were compared. Results: Both groups were similar with regards to preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in off-pump (group A) and on-pump (group B) patients during the operation. There were no significant differences in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate concentrations, lactate–pyruvate ratio and glycerol concentrations between off-pump versus on-pump patients. Pyruvate concentrations were higher in the off-pump group (p < 0.05), the lactate–pyruvate ratios indicating the aerobic/anaerobic metabolism status were lower in the off-pump group (p < 0.01) and the values of the concentrations of glycerol were lower in the off-pump group (p < 0.01). Conclusion: Dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both groups of patients (off-pump and on-pump). The presented preliminary results suggest that extracorporeal circulation during cardiac operations could compromise skeletal muscle energy metabolism.

Key Words: Cardiac surgery • Cardiopulmonary bypass • On-pump • Off-pump • Metabolism • Microdialysis

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				J Mandak, M Pojar, N Cibicek, V Lonsky, V Palicka, D Kakrdova, J Nedvidkova, J Kubicek, and P Zivny Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow Perfusion, November 1, 2008; 23(6): 339 - 346. [Abstract] [PDF]