A COMPARISON BETWEEN POSTOPERATIVE TROPONIN ELEVATION IN AN OFF-PUMP VERSUS CONVENTIONAL CORONARY ARTERY BYPASS GRAFT IN PREDICTING THE SHORT-TERM OUTCOME
Keywords:
cardiac troponin I, On-pump and Off-pump coronary artery bypass, Cardiopulmonary bypass
Abstract
Background: Although, advancements in techniques and perioperative management in coronary artery bypass surgery the elevation of postoperative troponin still occurs commonly. In this regard, we aimed to assess the degree of myocardial injury by measuring and comparing the levels of cardiac troponin I in the postoperative period of conventional versus off-pump coronary artery bypass graft and identify the most associated factors.
Patients and methods: This prospective cohort study included the patients who underwent conventional coronary artery bypass surgery (46 patients) and off-pump coronary artery bypass surgery (34 patients), at Azadi heart Center in Duhok province during the period between 25th November 2021 and 25th May 2022.
Results: The total amount of cardiac troponin release was significantly higher in the conventional than in the off-pump group. At one hour, the conventional means was 7.13 ng/ml while the off-pump was 1.56 ng/ml, p < 0.0001and at 24 hours, the convention mean was 5.51 ng/ml while the off-pump was 1.24 ng/ml, p < 0.001. The most associated factors in the conventional compared to the off-pump were advanced age, male gender, hypertension, renal impairment, Previous myocardial infarction, and timing of surgery. the main independent factors associated with cardiac troponin I elevation within 24 hours following conventional coronary artery bypass surgery were overweight, chronic renal failure, Smoking, and urgent procedure status.
Conclusion: This study showed that the patients who underwent the conventional group had significantly higher levels of troponin I at 1 hour and 24 hrs, postoperatively. The higher postoperative troponin I among patients who underwent the conventional group was associated with being overweight, smoking, having chronic renal failure, and using urgent procedure status
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References
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Albatrek, H, Ramadan, A & Yassen, Y (2022). Coronary artery bypass grafting in non-dialysis dependent chronic renal disease. The Egyptian Cardiothoracic Surgeon, 4(6): 92-96.
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Ascione, R, Lloyd, CT, Gomes, WJ, Caputo, M, Bryan, AJ & Angelini, GD (2002). Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. European journal of cardio-thoracic surgery, 15(5): 685-690.
Ascione, R, Williams, S, Lloyd, CT, Sundaramoorthi, T, Pitsis, AA & Angelini, GD (2001). Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. The Journal of thoracic and cardiovascular surgery, 121(4): 689-696.
Badruzzaman, M, Hossain, A, Adhikary, AB, Quader, SA, Kamal, S & Saha, SK (2010). Evaluation of myocardial protection in off-pump vs on-pump coronary bypass surgery by troponin I estimation. Bangladesh Medical Research Council Bulletin, 36(3): 93-96.
Bainbridge, D, Martin, J & Cheng, D. Off pump coronary artery bypass graft surgery versus conventional coronary artery bypass graft surgery: a systematic review of the literature. Seminars in cardiothoracic and vascular anesthesia, 2005. Westminster Publications, Inc. 708 Glen Cove Avenue, Glen Head, NY 11545, USA, 105-111.
Bappu, NJ, Venugopal, P, Bisoi, AK & Mankad, PS (2006). Troponin-I release after cardiac surgery with different surgical techniques and post-operative neurological outcomes. McGill Journal of Medicine: MJM, 9(2): 88.
Bonnefoy, E, Filley, S, Kirkorian, G, Guidollet, J, Roriz, R, Robin, J, et al. (2004). Troponin I, troponin T, or creatine kinase-MB to detect perioperative myocardial damage after coronary artery bypass surgery. Chest, 114(2): 482-486.
Brown, JR, Hernandez, F, Klemperer, JD, Clough, RA, DiPierro, FV, Hofmaster, PA, et al. Cardiac troponin T levels in on-and off-pump coronary artery bypass surgery. Heart Surgery Forum, 2007. FORUM MULTIMEDIA PUBLISHING, 12.
Caliskan, E, Güsewell, S, Seifert, B, Theusinger, OM, Starck, CT, Pavicevic, J, et al. (2014). Does body mass index impact the early outcome of surgical revascularization? A comparison between off-pump and on-pump coronary artery bypass grafting. Interactive cardiovascular and thoracic surgery, 19(5): 749-755.
Deb, S, Wijeysundera, HC, Ko, DT, Tsubota, H, Hill, S & Fremes, SE (2013). Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. Jama, 310(19): 2086-2095.
Doenst, T, Haverich, A, Serruys, P, Bonow, RO, Kappetein, P, Falk, V, et al. (2019). PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. Journal of the American College of Cardiology, 73(8): 964-976.
Domanski, MJ, Mahaffey, K, Hasselblad, V, Brener, SJ, Smith, PK, Hillis, G, et al. (2011). Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery. Jama, 305(6): 585-591.
Emerson, D & Trachiotis, G (2016). Conventional Coronary Artery Bypass Graft Surgery. World Journal of Cardiovascular Surgery, 6(4): 55-60.
Feigin, VL, Brainin, M, Norrving, B, Martins, S, Sacco, RL, Hacke, W, et al. (2022). World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 17(1): 18-29.
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Khan, MA, Hashim, MJ, Mustafa, H, Baniyas, MY, Al Suwaidi, SKBM, AlKatheeri, R, et al. (2020). Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus, 12(7).
Koppen, E, Madsen, E, Greiff, G, Stenseth, R, Pleym, H, Wiseth, R, et al. (2019). Perioperative factors associated with changes in troponin T during coronary artery bypass grafting. Journal of Cardiothoracic and Vascular Anesthesia, 33(12): 3309-3319.
Kuwahara, G & Tashiro, T (2020). Current status of off-pump coronary artery bypass. Annals of Thoracic and Cardiovascular Surgery, 26(3): 125.
Lim, CC, Cuculi, F, Van Gaal, WJ, Testa, L, Arnold, JR, Karamitsos, T, et al. (2011). Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: a study using biomarkers and cardiac magnetic resonance imaging. The Annals of thoracic surgery, 92(6): 2046-2053.
Lozano, R, Naghavi, M, Foreman, K, Lim, S, Shibuya, K, Aboyans, V, et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 380(9859): 2095-2128.
Lukkarinen, H & Hentinen, M (2006). Treatments of coronary artery disease improve quality of life in the long term. Nursing research, 55(1): 26-33.
Members, WC, Lawton, JS, Tamis-Holland, JE, Bangalore, S, Bates, ER, Beckie, TM, et al. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(2): e21-e129.
Munshi, SK, Halder, A & Bandyopadhyay, P (2020). Level of Cardiac Biomarkers in Immediate Post-Operative Period after Off-Pump CABG and Its Comparison with On-Pump CABG: A Prospective Analytical Study. World Journal of Cardiovascular Surgery, 10(10): 200-211.
Nader, ND, Khadra, WZ, Reich, NT, Bacon, DR, Salerno, TA & Panos, AL (2010). Blood product use in cardiac revascularization: comparison of on-and off-pump techniques. The Annals of thoracic surgery, 68(5): 1640-1643.
Phothikun, A, Nawarawong, W, Tantraworasin, A & Tepsuwan, T (2022). The outcomes of ultrafiltration in on-pump versus off-pump coronary artery bypass grafting in patients with renal impairment. Journal of Cardiothoracic Surgery, 17(1): 219.
Rivetti, LA & Gandra, SM (2007). Initial experience using an intraluminal shunt during revascularization of the beating heart. The Annals of thoracic surgery, 63(6): 1742-1747.
Sahdev, N, Hamid, O, Kyriazis, PG & Punjabi, PP 2023. Off Pump Coronary Artery Bypass Grafting. Essentials of Operative Cardiac Surgery. Springer.
Shaefi, S, Mittel, A, Loberman, D & Ramakrishna, H (2019). Off-pump versus on-pump coronary artery bypass grafting—a systematic review and analysis of clinical outcomes. Journal of cardiothoracic and vascular anesthesia, 33(1): 232-244.
Thielmann, M, Sharma, V, Al-Attar, N, Bulluck, H, Bisleri, G, Bunge, JJ, et al. (2017). ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. European heart journal, 38(31): 2392-2411.
Utley, JR, Leyland, SA, Fogarty, CM, Smith, WP, Knight, EB, Feldman, GJ, et al. (2001). Smoking is not a predictor of mortality and morbidity following coronary artery bypass grafting. Journal of cardiac surgery, 11(6): 377-384.
van Dijk, D, Nierich, AP, Jansen, EW, Nathoe, HM, Suyker, WJ, Diephuis, JC, et al. (2001). Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation, 104(15): 1761-1766.
van Domburg, RT, Meeter, K, van Berkel, DF, Veldkamp, RF, van Herwerden, LA & Bogers, AJ (2000). Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. Journal of the American College of Cardiology, 36(3): 878-883.
Vermes, E, Mesguich, M, Houel, R, Soustelle, C, Le Besnerais, P, Hillion, M-L, et al. (2000). Cardiac troponin I release after open heart surgery: a marker of myocardial protection? The Annals of thoracic surgery, 70(6): 2087-2090.
Wießner, R, Hannemann-Pohl, K, Ziebig, R, Grubitzsch, H, Hocher, B, Vargas-Hein, O, et al. (2008). Impact of kidney function on plasma troponin concentrations after coronary artery bypass grafting. Nephrology Dialysis Transplantation, 23(1): 231-238.
Wolff, G, Dimitroulis, D, Andreotti, F, Kołodziejczak, M, Jung, C, Scicchitano, P, et al. (2017). Survival benefits of invasive versus conservative strategies in heart failure in patients with reduced ejection fraction and coronary artery disease: a meta-analysis. Circulation: Heart Failure, 10(1): e003255.
Albatrek, H, Ramadan, A & Yassen, Y (2022). Coronary artery bypass grafting in non-dialysis dependent chronic renal disease. The Egyptian Cardiothoracic Surgeon, 4(6): 92-96.
Alwan, K, Falcoz, P-E, Alwan, J, Mouawad, W, Oujaimi, G, Chocron, S, et al. (2004). Beating versus arrested heart coronary revascularization: evaluation by cardiac troponin I release. The Annals of thoracic surgery, 77(6): 2051-2055.
Ascione, R, Lloyd, CT, Gomes, WJ, Caputo, M, Bryan, AJ & Angelini, GD (2002). Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. European journal of cardio-thoracic surgery, 15(5): 685-690.
Ascione, R, Williams, S, Lloyd, CT, Sundaramoorthi, T, Pitsis, AA & Angelini, GD (2001). Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. The Journal of thoracic and cardiovascular surgery, 121(4): 689-696.
Badruzzaman, M, Hossain, A, Adhikary, AB, Quader, SA, Kamal, S & Saha, SK (2010). Evaluation of myocardial protection in off-pump vs on-pump coronary bypass surgery by troponin I estimation. Bangladesh Medical Research Council Bulletin, 36(3): 93-96.
Bainbridge, D, Martin, J & Cheng, D. Off pump coronary artery bypass graft surgery versus conventional coronary artery bypass graft surgery: a systematic review of the literature. Seminars in cardiothoracic and vascular anesthesia, 2005. Westminster Publications, Inc. 708 Glen Cove Avenue, Glen Head, NY 11545, USA, 105-111.
Bappu, NJ, Venugopal, P, Bisoi, AK & Mankad, PS (2006). Troponin-I release after cardiac surgery with different surgical techniques and post-operative neurological outcomes. McGill Journal of Medicine: MJM, 9(2): 88.
Bonnefoy, E, Filley, S, Kirkorian, G, Guidollet, J, Roriz, R, Robin, J, et al. (2004). Troponin I, troponin T, or creatine kinase-MB to detect perioperative myocardial damage after coronary artery bypass surgery. Chest, 114(2): 482-486.
Brown, JR, Hernandez, F, Klemperer, JD, Clough, RA, DiPierro, FV, Hofmaster, PA, et al. Cardiac troponin T levels in on-and off-pump coronary artery bypass surgery. Heart Surgery Forum, 2007. FORUM MULTIMEDIA PUBLISHING, 12.
Caliskan, E, Güsewell, S, Seifert, B, Theusinger, OM, Starck, CT, Pavicevic, J, et al. (2014). Does body mass index impact the early outcome of surgical revascularization? A comparison between off-pump and on-pump coronary artery bypass grafting. Interactive cardiovascular and thoracic surgery, 19(5): 749-755.
Deb, S, Wijeysundera, HC, Ko, DT, Tsubota, H, Hill, S & Fremes, SE (2013). Coronary artery bypass graft surgery vs percutaneous interventions in coronary revascularization: a systematic review. Jama, 310(19): 2086-2095.
Doenst, T, Haverich, A, Serruys, P, Bonow, RO, Kappetein, P, Falk, V, et al. (2019). PCI and CABG for treating stable coronary artery disease: JACC review topic of the week. Journal of the American College of Cardiology, 73(8): 964-976.
Domanski, MJ, Mahaffey, K, Hasselblad, V, Brener, SJ, Smith, PK, Hillis, G, et al. (2011). Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery. Jama, 305(6): 585-591.
Emerson, D & Trachiotis, G (2016). Conventional Coronary Artery Bypass Graft Surgery. World Journal of Cardiovascular Surgery, 6(4): 55-60.
Feigin, VL, Brainin, M, Norrving, B, Martins, S, Sacco, RL, Hacke, W, et al. (2022). World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 17(1): 18-29.
Kathiresan, S, MacGillivray, TE, Lewandrowski, K, Servoss, SJ, Lewandrowski, E & Januzzi Jr, JL. Off-pump coronary bypass grafting is associated with less myocardial injury than coronary bypass surgery with cardiopulmonary bypass. The heart surgery forum, 2003. E174-8.
Khan, MA, Hashim, MJ, Mustafa, H, Baniyas, MY, Al Suwaidi, SKBM, AlKatheeri, R, et al. (2020). Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus, 12(7).
Koppen, E, Madsen, E, Greiff, G, Stenseth, R, Pleym, H, Wiseth, R, et al. (2019). Perioperative factors associated with changes in troponin T during coronary artery bypass grafting. Journal of Cardiothoracic and Vascular Anesthesia, 33(12): 3309-3319.
Kuwahara, G & Tashiro, T (2020). Current status of off-pump coronary artery bypass. Annals of Thoracic and Cardiovascular Surgery, 26(3): 125.
Lim, CC, Cuculi, F, Van Gaal, WJ, Testa, L, Arnold, JR, Karamitsos, T, et al. (2011). Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: a study using biomarkers and cardiac magnetic resonance imaging. The Annals of thoracic surgery, 92(6): 2046-2053.
Lozano, R, Naghavi, M, Foreman, K, Lim, S, Shibuya, K, Aboyans, V, et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 380(9859): 2095-2128.
Lukkarinen, H & Hentinen, M (2006). Treatments of coronary artery disease improve quality of life in the long term. Nursing research, 55(1): 26-33.
Members, WC, Lawton, JS, Tamis-Holland, JE, Bangalore, S, Bates, ER, Beckie, TM, et al. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(2): e21-e129.
Munshi, SK, Halder, A & Bandyopadhyay, P (2020). Level of Cardiac Biomarkers in Immediate Post-Operative Period after Off-Pump CABG and Its Comparison with On-Pump CABG: A Prospective Analytical Study. World Journal of Cardiovascular Surgery, 10(10): 200-211.
Nader, ND, Khadra, WZ, Reich, NT, Bacon, DR, Salerno, TA & Panos, AL (2010). Blood product use in cardiac revascularization: comparison of on-and off-pump techniques. The Annals of thoracic surgery, 68(5): 1640-1643.
Phothikun, A, Nawarawong, W, Tantraworasin, A & Tepsuwan, T (2022). The outcomes of ultrafiltration in on-pump versus off-pump coronary artery bypass grafting in patients with renal impairment. Journal of Cardiothoracic Surgery, 17(1): 219.
Rivetti, LA & Gandra, SM (2007). Initial experience using an intraluminal shunt during revascularization of the beating heart. The Annals of thoracic surgery, 63(6): 1742-1747.
Sahdev, N, Hamid, O, Kyriazis, PG & Punjabi, PP 2023. Off Pump Coronary Artery Bypass Grafting. Essentials of Operative Cardiac Surgery. Springer.
Shaefi, S, Mittel, A, Loberman, D & Ramakrishna, H (2019). Off-pump versus on-pump coronary artery bypass grafting—a systematic review and analysis of clinical outcomes. Journal of cardiothoracic and vascular anesthesia, 33(1): 232-244.
Thielmann, M, Sharma, V, Al-Attar, N, Bulluck, H, Bisleri, G, Bunge, JJ, et al. (2017). ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery. European heart journal, 38(31): 2392-2411.
Utley, JR, Leyland, SA, Fogarty, CM, Smith, WP, Knight, EB, Feldman, GJ, et al. (2001). Smoking is not a predictor of mortality and morbidity following coronary artery bypass grafting. Journal of cardiac surgery, 11(6): 377-384.
van Dijk, D, Nierich, AP, Jansen, EW, Nathoe, HM, Suyker, WJ, Diephuis, JC, et al. (2001). Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation, 104(15): 1761-1766.
van Domburg, RT, Meeter, K, van Berkel, DF, Veldkamp, RF, van Herwerden, LA & Bogers, AJ (2000). Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. Journal of the American College of Cardiology, 36(3): 878-883.
Vermes, E, Mesguich, M, Houel, R, Soustelle, C, Le Besnerais, P, Hillion, M-L, et al. (2000). Cardiac troponin I release after open heart surgery: a marker of myocardial protection? The Annals of thoracic surgery, 70(6): 2087-2090.
Wießner, R, Hannemann-Pohl, K, Ziebig, R, Grubitzsch, H, Hocher, B, Vargas-Hein, O, et al. (2008). Impact of kidney function on plasma troponin concentrations after coronary artery bypass grafting. Nephrology Dialysis Transplantation, 23(1): 231-238.
Wolff, G, Dimitroulis, D, Andreotti, F, Kołodziejczak, M, Jung, C, Scicchitano, P, et al. (2017). Survival benefits of invasive versus conservative strategies in heart failure in patients with reduced ejection fraction and coronary artery disease: a meta-analysis. Circulation: Heart Failure, 10(1): e003255.
Published
2023-05-11
How to Cite
AHMED, M. R., & BAHJET, A. S. (2023). A COMPARISON BETWEEN POSTOPERATIVE TROPONIN ELEVATION IN AN OFF-PUMP VERSUS CONVENTIONAL CORONARY ARTERY BYPASS GRAFT IN PREDICTING THE SHORT-TERM OUTCOME . Journal of Duhok University, 26(1), 211-223. https://doi.org/10.26682/sjuod.2023.26.1.20
Section
Pure and Engineering Sciences
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