Markers of myocardial ischemia after minimally invasive and conventional coronary operation.
BACKGROUND
The purpose of this study was to evaluate the course of serum markers of myocardial tissue damage after two different types of minimally invasive coronary surgical procedures (MICS) as compared with conventional coronary artery bypass grafting (CABG).


METHODS
We enrolled 87 patients with one- or two-vessel disease scheduled for one of the three procedures: minimally invasive direct coronary artery bypass grafting (MIDCABG) by lateral thoracotomy (n = 29), the OCTOPUS method by median sternotomy (n = 27), and CABG (n = 31). Creatine kinase activity (CK), creatine kinase MB activity (CK-MB act), creatine kinase MB mass concentration (CK-MB mass), myoglobin concentration (MG), and cardiac troponin I concentration (cTnI) were measured perioperatively until the second postoperative day.


RESULTS
Creatine kinase-MB, CK-MB mass, and cTnI were significantly higher after CABG and were nearly maintained within the normal range in MICS. Creatine kinase and MG were significantly lower in the OCTOPUS group than in the MIDCABG or CABG groups.


CONCLUSIONS
Minimally invasive coronary surgical procedures cause less myocardial injury than CABG as indicated by specific serum markers. However, higher CK and MG reflect more substantial skeletal muscle trauma during MIDCABG operation compared with OCTOPUS procedures.
Kilger
E
E
Department of Anesthesiology, Ludwig-Maximilian-University of Munich, Germany. erichkilger@ana.med.uni-muenchen.de
Pichler
B
B
Weis
F
F
Goetz
A
A
Lamm
P
P
Schütz
A
A
Muehlbayer
D
D
Frey
L
L
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D007527:Isoenzymes; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase