Intraoperative assessment of myocardial revascularisation for the relief of ischaemia using monophasic action potential recordings.
We have been concerned with developing a method of assessing regional myocardial perfusion which is simple, quick and without hazard to the patient. Monophasic action potential (MAP) recordings provide a highly sensitive measure of localised myocardial ischaemia. We have developed a hand-held pressure contact silver/silver chloride electrode for recording MAP signals from the left ventricular epicardium. The design enables it to slide within the pericardium on the left ventricle/epicardium with minimal displacement of the heart. Three protocols were adopted providing different permutations of atrial pacing and graft occlusion. Protocol 1: after discontinuing bypass, atrial pacing was established. After 90 s, all grafts were occluded for a period of 90 s. Protocol 2: after discontinuing bypass, all grafts were occluded for 90 s in the absence of pacing. Protocol 3: atrial pacing was established for 60 s before grafting and bypass and repeated subsequent to grafting and discontinuing bypass. Our results show that the most promising method is protocol 3. The most important results were that when heart rate is taken into account, the ischaemic changes in the MAP were significantly less impressive (P less than 0.05) following grafting. With further refinement, this technique may be applicable to the assessment of individual grafts.
Treasure
T
T
Middlesex Hospital, London, UK.
Taggart
P
P
Sutton
P
P
O'Brien
W
W
D000200:Action Potentials; D002985:Clinical Protocols; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery; D004566:Electrodes; D004867:Equipment Design; D006083:Graft Occlusion, Vascular / Q000503:physiopathology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007432:Intraoperative Period; D009204:Myocardial Revascularization / Q000379:methods*; D014680:Veins / Q000637:transplantation