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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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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