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Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting

Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, incl...

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Autores principales: Hellmann, Marcin, Piotrowski, Jakub, Kaszubowski, Mariusz, Dudziak, Maria, Anisimowicz, Lech
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141187/
https://www.ncbi.nlm.nih.gov/pubmed/32121485
http://dx.doi.org/10.3390/jcm9030663
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author Hellmann, Marcin
Piotrowski, Jakub
Kaszubowski, Mariusz
Dudziak, Maria
Anisimowicz, Lech
author_facet Hellmann, Marcin
Piotrowski, Jakub
Kaszubowski, Mariusz
Dudziak, Maria
Anisimowicz, Lech
author_sort Hellmann, Marcin
collection PubMed
description Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation.
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spelling pubmed-71411872020-04-10 Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting Hellmann, Marcin Piotrowski, Jakub Kaszubowski, Mariusz Dudziak, Maria Anisimowicz, Lech J Clin Med Article Coronary artery bypass grafting may be associated with several cardiac complications, including ischemia, acute myocardial infarction, arrhythmias, or hemodynamic instability. Accumulating evidence suggests that well-developed coronary collateral circulation may protect against adverse effects, including myocardial ischemia. Assessment of myocardial microvascular perfusion is, therefore, of great clinical interest in beating heart surgery. In this paper, myocardial microvascular perfusion is continuously assessed on the beating heart using laser Doppler flowmetry in consecutive patients who underwent coronary artery bypass grafting procedures. No significant (p = 0.110) differences were found between the averaged perfusion signal (n = 42) at the baseline, during artery occlusion, or after reperfusion (732.4 ± 148.0 vs. 711.4 ± 144.1 vs. 737.0 ± 141.2, respectively). In contrast, significantly different (p < 0.001) mean perfusion signals (n = 12) were found (805.4 ± 200.1 vs. 577.2 ± 212.8 vs. 649.3 ± 220.8) in a subset of patients who presented with hemodynamic instability and myocardial ischemia. Additionally, a strong positive correlation between the plasma levels of high-sensitivity troponin I and perfusion decrease level after artery occlusion was found (r = 0.854, p < 0.001). This study argues that myocardial microvascular perfusion remains constant during coronary artery bypass grafting on the beating heart in advanced coronary artery disease. This phenomenon is most likely due to an extensive coronary collateral circulation. MDPI 2020-03-01 /pmc/articles/PMC7141187/ /pubmed/32121485 http://dx.doi.org/10.3390/jcm9030663 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hellmann, Marcin
Piotrowski, Jakub
Kaszubowski, Mariusz
Dudziak, Maria
Anisimowicz, Lech
Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title_full Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title_fullStr Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title_full_unstemmed Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title_short Invasive Assessment of the Myocardial Microcirculation during Beating Heart Coronary Artery Bypass Grafting
title_sort invasive assessment of the myocardial microcirculation during beating heart coronary artery bypass grafting
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141187/
https://www.ncbi.nlm.nih.gov/pubmed/32121485
http://dx.doi.org/10.3390/jcm9030663
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