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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2002 June;43(3):307-11

language: English

Off-pump coronary bypass grafting to double vessel disease with the pharmacological assist of esmolol. An experimental study

Otaki M., Ogawa T., Inoue T., Oku H.

From the ­Department of Cardiac Surgery Kinki Uni­ver­sity Hos­pital, ­Osaka, ­Japan


Back­ground. To dem­on­strate the sur­gical effi­cacy and ­safety of off-­pump cor­o­nary ­bypass ­grafting to ­double- or ­triple-­vessel dis­ease, we per­formed off-­pump ­double ­bypass ­grafting ­using a ­brief ­local cor­o­nary occlu­sion ­with the phar­mac­o­log­ical ­assist of ­esmolol.
­Methods. ­These experi­ments ­were con­ducted in 30 ­canine ­hearts ­with the ­left ­internal tho­racic ­artery (ITA) ­grafted to the cir­cum­flex cor­o­nary ­artery (CFX) and the ­right ITA ­grafted to the ­left ante­rior ­descending cor­o­nary ­artery (LAD), off ­pump, ­using a ­brief ­local cor­o­nary occlu­sion ­through the ­left min­i­thor­a­cotomy. The cor­o­nary anas­tom­osis was per­formed ­using a ­brief ­local occlu­sion of the cor­o­nary ­artery. An anas­tom­osis ­between the ­left ITA and the CFX was ­done ­first, and ­then the ­right ITA and the LAD ­were anas­to­mosed. ­Thirty ani­mals ­were ­divided ­into 2 ­groups, ­group A (n=15) ­receiving ­esmolol ­just ­before (10 mg/kg on a ­bolus) and ­during the cor­o­nary ­artery occlu­sion (500 μg/kg/min con­tin­u­ously), and ­group B (n=15) ­without admin­is­trating ­esmolol as a con­trol.
­Results. Oper­a­tive ­deaths ­were 4 in ­group B and all of ­group A ani­mals sur­vived (p<0.05). All ­deaths ­were attrib­ut­able to ven­tric­ular arrhyth­mias ­during/­after cor­o­nary occlu­sion. ­Group B ani­mals neces­si­tating ­longer cor­o­nary occlu­sion ­time (­more ­than 15 min­) ­were ­more ­likely to fib­ril­late and ­more dif­fi­cult to resus­ci­tate ­than ­group A ani­mals ­requiring cor­o­nary occlu­sion ­time ­more ­than 15 min. Seg­mental short­ening on the ech­o­car­di­o­gram dem­on­strated no sig­nif­i­cant dif­fer­ence ­between ­group A and B in ­both ante­rior and pos­te­rior ­wall seg­ment. How­ever, ech­o­car­di­o­gram in ani­mals neces­si­tating cor­o­nary occlu­sion ­time ­more ­than 15 min­ dem­on­strated ­that seg­mental short­ening in ­group A ­were ­better ­than in ­group B (18 vs 11%, p<0.05), and com­par­a­tively ­greater but not sig­nif­i­cant in the pos­te­rior ­wall (19 vs 14%).
Con­clu­sions. The use of ­esmolol may be rec­om­mended to off-­pump cor­o­nary ­bypass ­even to the ­double-­vessel ­bypass, in ­order to ­make off-­pump ­approach ­safer.

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