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Ann Thorac Surg 2000;70:206-211
© 2000 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Myocardial outflow of prostacyclin in relation to metabolic stress during off-pump coronary artery bypass grafting

Ulf Lockowandt, MDa, Anders Öwall, MD, PhDb, Anders Franco-Cereceda, MD, PhDa

a Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden
b Department of Cardiothoracic Anesthesia, Karolinska Hospital, Stockholm, Sweden

Address reprint requests to Dr Lockowandt, Department of Thoracic Surgery, Karolinska Hospital, S-171 76 Stockholm, Sweden
e-mail: ulflockowandt{at}yahoo.com

Background. The metabolic changes, possible myocardial damage, and influence on the vascular endothelium during off-pump coronary artery bypass grafting have been investigated.

Methods. Coronary sinus and arterial blood samples were obtained before coronary arterial occlusion, after 10 minutes of ischemia, and after 1 and 10 minutes of reperfusion in 9 patients who had an anastomosis performed to the left anterior descending coronary artery off-pump bypass

Results. The mean ischemic time was 14 ± 1 minutes. The arteriovenous difference in lactate decreased during ischemia to reach a minimum at 1 minute of reperfusion (-0.15 ± 0.06 µmol/L compared to 0.21 ± 10 µmol/L before ischemia; p < 0.01). Myocardial lactate extraction decreased from 14.2 ± 6.8 µmol/min before ischemia to -10.9 ± 6.5 µmol/min after 1 minute of reperfusion (p < 0.01). Simultaneously, the arteriovenous difference in 6-keto-PGF1{alpha}, the stable metabolite of prostacyclin, decreased from -30 ± 26 pg/mL to -258 ± 80 pg/mL at 1 minute of reperfusion (p < 0.05), and the 6-keto-PGF1{alpha} extraction over the heart decreased -556 ± 466 pg/min to -18,560 ± 5,683 pg/min (p < 0.01).

Conclusions. The localized myocardial ischemia associated with these procedures causes changes in the myocardium and endothelial influence. Coronary bypass surgery performed on the beating heart may not be superior in preventing cardiac ischemia and endothelial disturbance, compared with conventional bypass surgery.




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