TITLE:
Level of Cardiac Biomarkers in Immediate Post-Operative Period after Off-Pump CABG and Its Comparison with On-Pump CABG: A Prospective Analytical Study
AUTHORS:
Sayar Kumar Munshi, Ashis Halder, Pares Bandyopadhyay
KEYWORDS:
Coronary Artery Bypass Grafting (CABG), Perioperative Period, Myocardial Damage, Cardiopulmonary Bypass, Cardiac Biomarkers
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.10 No.10,
October
30,
2020
ABSTRACT: Background: Coronary artery
bypass grafting (CABG) is an important modality of treatment for ischemic heart
disease. Both off-pump and on-pump CABG have direct effect on the level cardiac
biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB)
and aortic cross-clamping may cause additive myocardial damage leading to
further elevation of blood markers. The present study is aimed at measuring and
comparing the cardiac biomarker levels in immediate post-operative period after
on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who
underwent CABG from January 2015 to June 2016 on elective or emergency basis at
Nilratan Sircar Medical College & Hospital have been included in the study.
Total 106 patients were operated for CABG of which 75 patients were operated
for OPCAB and 31 patients were operated for ONCAB. For the comparison of
data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are
measured during anesthesia before surgery, post-operatively
after 1 hour, post-operatively after 4 hours and post-operatively after 20 hours. All recorded data are analyzed using standard statistical methods. Results: We found the markers are elevated immediately
after surgery and gradually come down within 24 hours after surgery in both OPCAB and ONCAB groups. The elevation is more after ONCAB than
OPCAB group in immediate post-operative period but the difference is not
significant after 20 hours of surgery. Conclusion: Elevated levels of
cardiac biomarkers in the immediate post-operative period indicate myocardial
damage during surgery, especially after ONCAB in comparison to OPCAB. This may
attribute to the better hemodynamic stability in the immediate post-operative
period after OPCAB than ONCAB assuming comparable and adequate
revascularization in patients of both groups. The avoidance of CPB and
cross-clamp may explain better myocardial functioning immediately after OPCAB. But after 20
hours, the level of cardiac markers is comparable in both groups indicating
little difference in post-operative recovery and long-term prognosis.