Myocardial injury during reoperation for coronary artery bypass surgery.
OBJECTIVE
To determine the incidence, triggers, and timing of myocardial injury during reoperation for coronary artery bypass surgery.


METHODS
Prospective observational.


METHODS
One tertiary care university hospital.


METHODS
15 patients undergoing reoperation.


METHODS
Multilead electrocardiographic monitoring approximately every 3 minutes during surgery.


RESULTS
The occurrence of a new ischemic ST elevation or depression on the electrocardiogram (ECG) was determined. A major deterioration in ventricular function after cardiopulmonary bypass (CPB) also was determined. Peak creatine kinase myocardial band (CK-MB) > or = 25 IU/L was considered to be the marker of myocardial injury. Seven patients demonstrated myocardial injury, all intraoperatively. Five of these patients had new ST elevation episodes before CPB. Three of the episodes were temporally associated with an abrupt increase in the heart rate. The other two episodes were temporally associated with surgical manipulation of the heart and the old grafts. The sixth patient had a significant deterioration of ventricular function during CPB. One of the patients who had ST elevation before CPB and the seventh patient developed ST elevation towards the end of protamine administration.


CONCLUSIONS
In patients undergoing reoperation, the intraoperative incidence of myocardial injury, especially before CPB, was found to be substantially higher than that previously reported.
Jain
U
U
Department of Anesthesia, University of California, San Francisco, CA, USA.
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000150:complications; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000209:etiology*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010197:Pancuronium / Q000008:administration & dosage; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D012086:Reoperation; D018754:Ventricular Dysfunction / Q000209:etiology
D006494:Heparin Antagonists; D007527:Isoenzymes; D003473:Neuromuscular Nondepolarizing Agents; D011479:Protamines; D003402:Creatine Kinase; D010197:Pancuronium