Although several clinical trials have compared surgical outcomes between off-pump and on-pump coronary artery bypass grafting (CABG), whether there is a difference in the early- and medium-term postoperative coronary microvascular functions is not fully understood. We compared short- and medium-term coronary microvascular function after off-pump and on-pump CABG.
A prospective study of patients undergoing off-pump and on-pump CABG. Eighty-two patients scheduled for CABG were recruited: 38 underwent off-pump surgery and 44 on-pump surgery. Each participant's coronary flow reserve (CFR) and diastolic function were measured with transthoracic Doppler echocardiography six and 12 months after surgery.
Baseline and hyperaemic diastolic peak flow velocity in the left anterior descending artery were similar in both groups, as was CFR (2.22±0.66) in the off-pump group compared with (2.13±0.61) in the on-pump group, (P = 0.54). Coronary flow reserve was significantly and inversely correlated with high sensitivity C-reactive protein concentration (r = −0.416; P < 0.001) and positively correlated with mitral E/A-wave velocity ratio (r = 0.247; P = 0.02). Stepwise linear regression analysis revealed that only high sensitivity C-reactive protein concentration was independently correlated with CFR (β = −0.272, P = 0.02).
Heart-lung bypass technique had no medium-term influence on the coronary microcirculation, despite a possible initial unfavourable effect. Serum hs-CRP concentration was an independent predictor of medium-term coronary microvascular dysfunction.
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- Off-pump versus on-pump coronary artery bypass grafting.Curr Cardiol Rep. 2014; 16: 455
- Impact of endoscopic versus open saphenous vein harvest technique on late coronary artery bypass grafting patient outcomes in the ROOBY (Randomized On/Off Bypass) Trial.J Thorac Cardiovasc Surg. 2011; 141: 338-344
- Microvascular dysfunction in angiographically normal or mildly diseased coronary arteries predicts adverse cardiovascular long-term outcome.Coron Artery Dis. 2004; 15: 259-264
- Adenosine-induced coronary vasodilation during transesophageal Doppler echocardiography. Rapid and safe measurement of coronary flow reserve ratio can predict significant left anterior descending coronary stenosis.Circulation. 1995; 92: 190-196
- Phasic coronary blood flow velocity in intramural and epicardial coronary arteries.Circ Res. 1982; 50: 775-781
- Assessment of coronary flow velocity reserve by transthoracic Doppler echocardiography before and after coronary artery bypass grafting.Am J Cardiol. 2011; 107: 1324-1328
- Comparison of blood-flow velocity waveforms in different coronary artery bypass grafts. Sequential saphenous vein grafts and internal mammary artery grafts.Circulation. 1988; 78: 1210-1217
- Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents.Am J Cardiol. 2003; 91: 522-526
- Role of coronary artery lumen enlargement in improving coronary blood flow after balloon angioplasty and stenting: a combined intravascular ultrasound Doppler flow and imaging study.J Am Coll Cardiol. 1997; 29: 1520-1527
- Impaired coronary microvascular and left ventricular diastolic functions in patients with ankylosing spondylitis.Atherosclerosis. 2008; 196: 306-312
- Interrelation of RDW and coronary flow reserve in patient with idiopathic dilated cardiomyopathy.Anadolu Kardiyol Derg. 2014; 14: 342-348
- on behalf of the CORONARY Investigators: Off-pump or on-pump coronary-artery bypass grafting at 30 days.N Engl J Med. 2012; 366: 1489-1497
- Early and midterm results of off-pump coronary artery bypass grafting.Ann Thorac Surg. 2007; 83: 115-119
- Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia.Ann Thorac Surg. 2009; 88: 1340-1396
- Distinct alterations in sublingual microcirculatory blood flow and hemoglobin oxygenation in on-pump and off-pump coronary artery bypass graft surgery.J Cardiothorac Vasc Anesth. 2011; 25: 784-790
- Microcirculatory perfusion is preserved during off-pump but not on-pump cardiac surgery.J Cardiothorac Vasc Anesth. 2014; 28: 336-341
- Noninvasive assessment of coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography. Comparison with invasive technique.J Am Coll Cardiol. 1998; 32: 1251-1259
- Persistent but reversible microvascular dysfunction after bypass grafting.Am J Physiol Heart Circ Physiol. 2000; 279: 2634-2640
- Functional evaluation of internal mammary artery bypass grafts in the early and late postoperative periods.J Am Coll Cardiol. 1995; 25: 1120-1128
- Coronary reoperation with and without cardiopulmonary bypass.Clin Res Cardiol. 2006; 95: 93-98
- Early and Midterm Outcome of Redo Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Bypass.Korean J Thorac Cardiovasc Surg. 2014; 47: 225-232
- Coronary artery surgery results 2005 in Japan.Ann Thorac Cardiovasc Surg. 2007; 13: 220-223
Published online: March 19, 2016
Accepted: February 18, 2016
Received in revised form: February 16, 2016
Received: December 14, 2015
© 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.