¡°Polarizing¡± microplegia improves cardiac cycle efficiency after CABG for unstable angina

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• 作者：Francesco Onorati ; Francesco Santini ; Rajesh D ; ale ; Grazia Ucci ; Kostantinos Pechlivanidis ; Tiziano Menon ; Bartolomeo Chiominto ; Alesss ; ro Mazzucco ; Giuseppe Faggian
• 关键词：Microplegia ; Myocardial protection ; Unstable angina ; Coronary artery bypass grafting
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：10 September, 2013
• 年：2013
• 卷：167
• 期：6
• 页码：2739-2746
• 全文大小：567 K

文摘

Background

Myocardial protection during coronary artery bypass grafting (CABG) for unstable angina (UA) still represents a major challenge, ought to the risk for further ischemia/reperfusion injury. Few studies investigate the biochemical, hemodynamic and echocardiographic results of microplegia (Mic) in UA.

Methods

Eighty UA-patients undergoing CABG were randomized to Mic (Mic-Group) or standard 4:1 blood Buckberg-cardioplegia (Buck-Group). Troponin-I and lactate were sampled from coronary sinus at reperfusion (T1), and from peripheral blood preoperatively (T0), at 6 (T2), 12 (T3) and 48 (T4) hours. Cardiac index (CI), indexed systemic vascular resistances (ISVR), ¦¤p/¦¤t, cardiac cycle efficiency (CCE), and central venous pressure (CVP) were collected preoperatively (T0), and since Intensive Care Unit (ICU)-arrival (T1) to 24 h (T5). Echocardiographic E-wave (E), A-wave (A), E/A, peak early-diastolic TDI-mitral annular-velocity (Ea), and E/Ea investigated the diastolic function and Wall Motion Score Index (WMSI) the systolic function, preoperatively (T0) and at 96 h (T1).

Results

Mic-Group showed lower troponin-I and lactate from coronary sinus (p = .0001 for both) and during the postoperative course (between-groups p = .001 and .0001, respectively). WMSI improved only after Mic (time-p = .001). Higher CI ¦¤p/¦¤t and CCE (between-groups p = .0001), with comparable CVP and ISVR (p = N.S.) were detected after Mic. Diastolic function improved in both groups, but better after Mic (between-groups p = .003, .001, and .013 for E, E/A, and Ea, respectively). Mic resulted in lower transfusions (p = .006) and hospitalization (p = .002), and a trend towards lower need/duration of inotropes (p = .04 and p = .041, respectively), and ICU-stay (p = .015).

Conclusion

Microplegia attenuates myocardial damage in UA, reduces transfusions, improves postoperative systo-diastolic function, and shortens hospitalization.