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Ann Thorac Surg 2001;71:565-570
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Myocardial preservation during coronary surgery with and without cardiopulmonary bypass

Hannu J. Penttilä, MDa, Martti V.K. Lepojärvi, MDb, Kai T. Kiviluoma, MDa, Päivi K. Kaukoranta, MDa, Ilmo E. Hassinen, MDc, Keijo J. Peuhkurinen, MDd

a Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
b Department of Thoracic Surgery, Oulu University Hospital, Oulu, Finland
c Department of Medical Biochemistry, Oulu University, Oulu, Finland
d Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland

Accepted for publication June 5, 2000.

Address reprint requests to Dr Penttilä, Department of Anesthesiology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
e-mail: hannu.penttila{at}oulu.fi

Background. There is increased interest in coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), although the preservation of the myocardium under such circumstances has not been properly investigated. The aim of this randomized study was to compare the changes in myocardial metabolism during CABG with and without CPB.

Methods. Myocardial energy metabolism and tissue injury during CABG was monitored in a series of 22 patients (11 with and 11 without CPB).

Results. The maximum myocardial lactate production was significantly higher (p = 0.02) in the group operated with CPB (0.56 mmol/L) than without it (0.17 mmol/L). A similar phenomenon was seen in the transcardiac pH differences (0.085 and 0.034 with and without CPB, p = 0.007). The postoperative peak values of creatine kinase-MB mass (15.1 vs 6.3 µg/L) and troponin I (13.8 vs 5.2 µg/L) were significantly higher (p < 0.001 and p = 0.008) with than without CPB.

Conclusions. CABG on a beating heart is associated with better myocardial energy preservation and less myocardial damage compared with conventional CABG with CPB and intermittent antegrade mild hypothermic blood cardioplegia.


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