XXXX in coronary bypass surgery using on-pump, beating heart technique with pressure- and volume-controlled coronary perfusion.

@entity1 @entity66 @entity63 @entity3979 @entity1188 @entity951 @entity1167 @entity3980 @entity583 @entity850
BACKGROUND: Even with the current aerobic techniques in myocardial protection, perioperative @entity583 can still occur. In this study, we sought to find out whether there is a method-specific mechanism of @entity63 in coronary bypass surgery using an on-pump beating heart technique. For this reason, we investigated localization and the extent of @entity583 in correlation to the severity of @entity3979 . We discuss strategies for reduction of @entity1188 incidence. METHODS: 34 @entity1 , who after isolated coronary bypass procedure developed non-Q or Q wave @entity1188 were selected for the study. In 12 of 34 @entity1 (group A) beating heart technique and in 22 of 34 @entity1 (group B) @entity1167 was used for myocardial protection. The study was conducted retrospectively and included @entity1 with stable, unstable, and @entity951 without preoperative enzymatic evidence of @entity63 and with technically noncomplicated coronary bypass grafting. Excluded from the study were emergency and redo procedures. In group A, in all instances, the left anterior descending artery was grafted as the last vessel and while distal anastomoses were constructed, coronary perfusion was maintained by using a perfusion catheter. RESULTS: Most @entity1 in both groups had @entity66 (10 of 12 @entity1 group A; 17 of 22 @entity1 group B), all @entity1 received complete revascularization; 7 of 12 @entity1 in group A and 5 of 22 @entity1 in group B had significant or critical left main stem @entity850 . In group A, 11 @entity1188 occurred in @entity3980 -(12 stenotic), 1 in CX-(11 stenotic), and 1 in RCA-(11 stenotic) supply area, four were Q wave @entity1188 . In group B, eight @entity1188 occurred in @entity3980 (22 stenotic), four in CX (17 stenotic), and 14 in RCA (20 stenotic) supply area, eight were Q wave @entity1188 . In group A, the @entity1188 incidence in the @entity3980 area was 10-times higher than in CX and RCA areas. In group B, the @entity1188 incidence in the RCA area was 2- and 3-times higher than in the @entity3980 and CX areas, respectively. In both groups no correlation between @entity1188 incidence and severity of @entity850 was observed. CONCLUSIONS: Using an on-pump beating heart technique, higher coronary perfusion pressures, avoidance of extreme upward retraction of the heart during revascularization of the CX-branch, as well as choosing the revascularization of the @entity3980 as the first vessel, could possibly contribute to better myocardial protection. In @entity1167 with cardioplegic solution, the right ventricle is probably more susceptible to @entity63 , especially when RCA is poorly collateralized. For adequate protection, choosing the revascularization of the RCA as the first vessel with immediate repeated cardioplegia via a RCA graft, higher perfusion pressures and antegrade with retrograde cardioplegia delivery, may be advantageous.
