Myocardial ischemia serum markers in coronary artery bypass grafting by on-pump and off-pump techniques

الملخص EN

Background : Coronary Artery Bypass Grafting (CABG) is usually performed with Cardio Pulmonary Bypass (CPB).

However CPB has been as sociated with several adverse effects.

Recently off-pump CABG technique is offered as an alternative to the standard on-pump technique.

The purpose of this study was to evaluate the safety of the technique by estimating and comparing serum markers of myocardial ischemia; CK, CK-MB, LDH, AST, Cardiac Troponin 1 and some peri and postoperative complications after two types of surgical procedures. Patients and Methods : Seventy-three patients (58 males and 15 females) with angiographic ally defined CAD admitted to the hospital for CABG was selected.

The off-pump technique was performed in 38 patients with mean age of 60±10.5 years.

In 35 other patients with mean age of 55 ± 10.4 years, the on-pump technique was applied.

CK, CK,MB, LDH and AST activities and Cardiac Troponin 1 concentration were measured pre and postoperatively into first 24 hours.

Characteristics of the patiaents and some pre and postoperative data regarding incidence of complications were also recorded. Results : The activities of cardiac enzymes ; CK, CK-MB, LDH and AST after on-pump CABG technique were higher than those of off-pump technique (P < 0.05 in all cases).

The levels of Troponin I were significantly higher after on-pump CABG throughout the entire measurement period (P < 0.01).

in other groups of the patients no preoperative myocardial infarction was observed.

In the off-pump technique procedure time was shorter and transfusion of blood and blood products was less than those of on-pump technique, but no differences were noticed among the other recorded data. Conclusion : Significantly lower release of the enzymes and Troponin 1 during operation by off-pump technique suggests that the technique causes less myocardial injury.

On the basis of little change in the activities of cardiac enzymes and Troponin 1 and presented data including a marked decrease in blood transfusion and shorter procedural time it is concluded that off-pump CABG is a safe and effective technique in selected patients with appropriate coronary lesions.