Metabolic derangement and cardiac injury early after reperfusion following intermittent cross-clamp fibrillation in patients undergoing coronary artery bypass graft surgery using conventional or miniaturized cardiopulmonary bypass

Bao A V Nguyen, M-Saadeh Suleiman, Jonathan R Anderson, Paul C Evans, Francesca Fiorentino, Barnaby C Reeves, Gianni D Angelini

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Myocardial ischemic stress and early reperfusion injury in patients undergoing coronary artery bypass grafting (CABG) operated on using intermittent cross-clamp fibrillation (ICCF) are not presently known. The role of mini-cardiopulmonary bypass (mCPB) versus conventional CPB (cCPB) during ICCF has not been investigated. These issues have been addressed as secondary objective of randomised controlled trial (ISRCTN30610605) comparing cCPB and mCPB. Twenty-six patients undergoing primary elective CABG using ICCF were randomised to either cCPB or mCPB. Paired left ventricular biopsies collected from 21 patients at the beginning and at the end of CPB were used to measure intracellular substrates (ATP and related compounds). Cardiac troponin T (cTnT) and CK-MB levels were measured in plasma collected from all patients preoperatively and after 1, 30, 60, 120, and 300 min after institution of CPB. ICCF was associated with significant ischemic stress as seen by fall in energy-rich phosphates early after reperfusion. There was also a fall in nicotinamide adenine dinucleotide (NAD(+)) indicating cardiomyocyte death which was confirmed by early release of cTnT and CK-MB during CPB. Ischemic stress and early myocardial injury were similar for cCPB and mCPB. However, the overall cardiac injury was significantly lower in the mCPB group as measured by cTnT (mean ± SEM: 96 ± 14 vs. 59 ± 8 µg/l, p = 0.02), but not with CK-MB. ICCF is associated with significant metabolic derangement and early myocardial injury. This early outcome was not affected by the CPB technique. However, the overall cardiac injury was lower for mCPB only when measured using cTnT.

Original languageEnglish
Pages (from-to)167-75
Number of pages9
JournalMolecular and Cellular Biochemistry
Volume395
Issue number1-2
DOIs
Publication statusPublished - Oct 2014

Structured keywords

  • BTC (Bristol Trials Centre)
  • Centre for Surgical Research

Keywords

  • Adenosine Triphosphate/metabolism
  • Aged
  • Cardiopulmonary Bypass/adverse effects
  • Coronary Artery Bypass/adverse effects
  • Creatine Kinase/blood
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Reperfusion Injury/blood
  • Preoperative Care
  • Troponin C/blood

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