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The Annals of Thoracic Surgery, Vol 33, 139-144, Copyright © 1982 by The Society of Thoracic Surgeons

ARTICLES

Detection of myocardial injury after coronary artery bypass grafting using a hypothermic, cardioplegic technique

HG McDaniel, JG Reves, NT Kouchoukos, LR Smith, WJ Rogers, PN Samuelson and WA Lell

Fifty patients undergoing isolated coronary artery bypass grafting procedures using a clear, cold cardioplegic solution, topical hypothermia, and reduced systemic flow for intraoperative myocardial protection were evaluated for myocardial injury by serial plasma creatine kinase-MB isoenzyme (CK-MB) measurements and electrocardiograms. Forty-one (82%) of the patients had three-vessel disease. Preoperative left ventricular contractility determined angiographically was normal in 13 patients (26%), mildly abnormal in 26 (52%), and moderately or severely abnormal in 11 (22%). The number of arteries grafted ranged from 2 to 6 (mean, 3.5). The mean duration of aortic clamping was 38.6 +/- 1.6 minutes. There were no hospital deaths. Enzymatic and electrocardiographic (ECG) evidence of myocardial infarction occurred in 1 patient. Nonspecific ECG changes occurred in 16 patients (32%), and th electrocardiograms were unchanged in the remaining 33 patients (66%). In the 49 patients without ECG evidence of infarction, the mean peak plasma CK-MB value, which occurred 6 hours after the onset of cardiopulmonary bypass, was 7.9 +/- 0.8 IU/L (standard error of the mean) and the mean integrated area 158 +/- 19.5 IU/L X hours. There was no correlation between these CK-MB values and the extent of disease, number of arteries grafted, or the duration of myocardial ischemia. These data document a low incidence of perioperative myocardial injury with this technique, and can serve as a baseline for comparison with other techniques for intraoperative myocardial protection in this setting.


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 Eur. J. Cardiothorac. Surg.Home page
A. M. Fabricius, W. Gerber, M. Hanke, J. Garbade, R. Autschbach, and F. W. Mohr
Early angiographic control of perioperative ischemia after coronary artery bypass grafting
Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 853 - 858.
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