Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study☆

Pojar, Marek; Mandak, Jiri; Cibíček, Norbert; Lonský, Vladimír; Dominik, Jan; Palička, Vladimír; Kubícek, J

doi:10.1016/j.ejcts.2008.01.039

Cited by 21 publications

(18 citation statements)

References 23 publications

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“…It has been demonstrated that off-pump surgery confers better post-operative renal function, less incidence of metabolic acidosis and oxidative stress, reduced myocardial injury, and lower activation of the inflammatory mediators than cardiopulmonary bypass. In fact, off-pump surgery leads to considerably lower metabolic disturbances than on-pump CABG [21]. Some studies have revealed that patients undergoing on-pump surgery tend to develop peripheral hypo perfusion and hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

Arefizadeh¹,

Hariri²,

Moghadam³

2017

Open Access Maced J Med Sci

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BACKGROUND:A few studies have compared the cardiac rehabilitation (CR) outcome between those who undergo conventional on-pump bypass surgery and off-pump surgery. We compared this outcome among the patients differentiated by the On-pump and off-pump surgical procedures about cardiovascular variables and psychological status.METHODS:This longitudinal study recruited 318 and 102 consecutive patients who had undergone CABG (on-pump surgery, n = 318 and off-pump surgery, n = 102) and been referred to the CR clinic.RESULTS:The off-pump surgery patients had more improvement in their metabolic equivalents (METs) value. The physical and mental components of health-related quality of life (QOL) (based on SF-36 questionnaire) as well as depression-anxiety (based on Costello-Comrey Depression and Anxiety Scale) were notably improved in the two study groups after the CR program, while changes in the QOL components scores and also depression-anxiety score were not different between the off-pump and on-pump techniques.CONCLUSIONS:Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.

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Section: Discussionmentioning

confidence: 99%

Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

Arefizadeh¹,

Hariri²,

Moghadam³

2017

Open Access Maced J Med Sci

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“…Cardiac surgery with or without cardiopulmonary bypass induces disturbed fluid balance and cardiac output [ 16 , 17 ], as it was demonstrated in this observational study with reduced S v O 2 after surgery as well as by an increased lactate concentration and base deficit. Clinical studies addressing tissue perfusion and energy metabolism in the perioperative period using microdialysis of the deltoid muscle were contradictory regarding differences between off-pump and on-pump surgery [ 18 , 19 ]. In our study, a subgroup analysis demonstrated no differences between off-pump and on-pump surgery for tissue oxygenation.…”

Section: Discussionmentioning

confidence: 99%

Tissue oxygen saturation as an early indicator of delayed lactate clearance after cardiac surgery: a prospective observational study

et al. 2015

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BackgroundIn this observational study near infrared spectroscopy (NIRS) was evaluated as a non-invasive monitor of impaired tissue oxygenation (StO2) after cardiac surgery. StO2, cardiac output, mixed venous oxygen saturation and mean arterial pressure were compared with lactate clearance as established measure for sufficient tissue perfusion and oxygen metabolism.MethodsForty patients after cardiac surgery (24 aortocoronary bypass grafting, 5 heart valve, 3 ascending aorta and 8 combined procedures) were monitored until postoperative day 1 with NIRS of the thenar muscle (InSpectra™ StO2-monitor, Hutchinson Technology), a pulmonary-artery catheter and intermittent blood gas analyses for the assessment of lactate clearance.ResultsStO2 was reduced 4 h after surgery (75 ± 6 %), but recovered at day 1 (84 ± 5 %), while lactate concentration remained increased. Using uni- and multivariate regression analysis, minimum StO2 (r = 0.46, p <0.01) and cardiac index (r = 0.40, p <0.05) correlated with lactate clearance at day 1, while minimum mixed venous saturation and mean arterial pressure did not. In a receiver-operating characteristics (ROC) analysis, minimum StO2 (with a threshold of 75 %) predicted a lactate clearance <10 % at day 1 with an area under the ROC-curve of 0.83, a sensitivity of 78 % and a specificity of 88 %. In the subgroup with StO2 <75 %, troponin and creatine kinase MB were significantly increased at day 1.ConclusionsStO2 below 75 % in the first hours after surgery was a better early indicator of persistent impaired lactate clearance at day 1 than cardiac index, mixed venous oxygen saturation or mean arterial pressure.

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“…However, when looking at the literature, it is evident that the significance, source and clinical implications of changes in blood lactate levels during cardiac surgery remain still unresolved. Elevated levels of blood lactate have been observed also following off-pump coronary artery bypass grafting, although to less extent than the conventional coronary surgery with CPB (CABG) [20]. Others have suggested that hypothermia, particularly in skeletal muscles, could be triggering lactate release in these patients [21].…”

Section: Discussionmentioning

confidence: 99%

Source, Triggers and Clinical Implications of Hyperlactemia in Patients Undergoing Mitral Valve Surgery Using Custodiol Cardioplegia

Ascione¹,

Venturini²,

Polesel³

et al. 2013

WJCS

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Background: Postoperative blood hyperlactaemia is an indicator of organ anaerobic metabolism and is associated with morbidity after cardiac surgery. This prospective study aims to explore the source, triggers and clinical implications for hyperlactaemia in patients undergoing mitral valve surgery using Custodiol cardioplegia. Methods: Twenty consecutive elective patients undergoing open-heart surgery for mitral valve repair/replacement using Custodiol (based on Bretschneider's HTK-solution) cardioplegia were recruited. A serial measurement of arterial blood lactate was performed. Pre-, intra-and post-operative clinical data were obtained and cardiac injury was determined by serial plasma measurement of postoperative release of CK-MB. Results: There were no in-hospital deaths. Most of the patients (n = 16) needed intraoperative direct current cardioversion to treat ventricular arrhythmias or post-operative vasopressors (n = 13) to treat vasoplegia. There was significant cardiac injury as determined by the marked increase of serum CK-MB (p < 0.05). A significant (p < 0.05) increase in blood lactate was found to follow a biphasic profile. The first peak (from 0.54 ± 0.03 to 1.3 ± 0.07 mM) was observed immediately following the release of the aortic cross-clamp and remained high for 1 hour. This was followed by a second peak at 12 hours postoperatively (1.9 ± 0.2 mM). The second rise in lactate was seen only in patients that required post-operative vasopressors (1.3 ± 0.2 vs 2.2 ± 0.3 mM, p < 0.05), in whom a significant late decrease in CVP was also observed (12.2 ± 1.0 to 7.7 ± 1.0 for 1 and 12 hours postoperative, respectively). Hyperlactaemia did not correlate with any other variables including CK-MB levels, cross-clamp or cardiopulmonary bypass time. Conclusions: In patients undergoing mitral valve surgery with Custodiol cardioplegia there is marked cardiac injury and a biphasic release of blood lactate. The initial peak in lactate occurs immediately following unclamping the aorta and is likely to be of organ (e.g. heart and lungs) origin. A second peak is only seen in patients requiring postoperative vasopressors to treat vasoplegia. Hyperlactaemia following mitral valve surgery with Custodiol cardioplegia does not seem to be related to myocardial injury as expressed by CK-MB release.

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Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study☆

Cited by 21 publications

References 23 publications

Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

Tissue oxygen saturation as an early indicator of delayed lactate clearance after cardiac surgery: a prospective observational study

Source, Triggers and Clinical Implications of Hyperlactemia in Patients Undergoing Mitral Valve Surgery Using Custodiol Cardioplegia

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