Myocardial damage after minimally invasive coronary artery bypass grafting on the beating heart.
BACKGROUND
In conventional coronary artery bypass grafting, the rate of perioperative myocardial infarction is reported in the 2% to 6% range; however, significantly higher rates are observed if sensitive myocardial marker proteins are used to detect perioperative myocardial damage. For minimally invasive direct coronary artery bypass grafting, few data are available concerning myocardial marker protein release.


METHODS
Fifteen consecutive patients (11 male, 4 female; mean age, 59.6 +/- 8.5 years) received minimally invasive direct coronary artery bypass grafting procedures via minithoracotomy on the beating heart. Electrocardiography and transesophageal and transthoracic echocardiography as well as determination of creatine kinase-MB mass concentration and cardiac troponin I level were used for ischemic monitoring.


RESULTS
One patient had a perioperative myocardial infarction according to standard criteria and died despite mechanical circulatory support. Determination of cardiac troponin I level showed small but definitive ischemic damage in 4 of 9 patients (44%) who presented transient ischemic signs intraoperatively or postoperatively. In 2 of these 4 patients pathologic findings could be detected on angiographic restudies.


CONCLUSIONS
Subclinical myocardial injury is a common event in minimally invasive coronary artery bypass grafting on the beating heart. Cardiac troponin I could serve as an adequate diagnostic tool for diagnosis of perioperative myocardial infarction in minimally invasive direct coronary artery bypass grafting.
Department of Anesthesiology and General Intensive Care, University of Innsbruck, Austria. johannes.o.bonatti@uibk.ac.at
J
J
Bonatti
H
H
Hangler
C
C
Hörmann
J
J
Mair
J
J
Falkensammer
P
P
Mair
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I