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J Thorac Cardiovasc Surg 1997;114:509-510
© 1997 Mosby, Inc.

BRIEF COMMUNICATIONS

TROPONIN I RELEASE DURING MINIMALLY INVASIVE CORONARY ARTERY SURGERY

Bristol, United Kingdom

From the Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom.

Received for publication April 1, 1997; accepted for publication April 9, 1997. Address for reprints: Gianni D. Angelini, FRCS, British Heart Foundation, Professor of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.

Revascularization of the left anterior descending artery (LAD) without cardiopulmonary bypass through a left anterior small thoracotomy (LAST) ¹ increasing in popularity. This has been driven partly by current trends toward cost containment, ² despite the fact that the effectiveness of the surgical procedure both in terms of early and long-term outcome are still under evaluation. One concern is the potential risk of ischemic damage to the warm, metabolically active myocardium during occlusion of the LAD. To investigate this further, we measured troponin I, a highly specific marker for the detection of myocardial injury, ³ in 14 selected patients (13 men, mean age 58 years) undergoing LAD revascularization via with LAST operation. These were compared with a control group of 14 patients (12 men, mean age 57 years) and undergoing myocardial revascularization of one or two arteries with the use of normothermic cardiopulmonary bypass and warm blood cardioplegia. All patients underwent elective operations and had well-preserved left ventricular function. Blood samples were collected for troponin I estimation before the operation and 4, 12, 24, 26, and 48 hours after the operation.

The two groups were similar with respect to preoperative characteristics. No patient had clinical or electrocardiographic evidence of preioperative myocardial infarction. Cardiopulmonary bypass time in the control group was 49 ± 8 minutes during which time a mean of $1.5 ± 0.5 distal anastomoses were performed. The ischemic times in the control and LAST groups were 24 ± 5 minutes and 37 ± 8 minutes, respectively. Preoperative troponin I concentrations were undetectable in both groups. In the control group, a significant rise in troponin I concentrations was observed 4 hours after the operation; the peak occurred at 12 hours, and the concentration remained significantly higher than preoperative levels even at 48 hours (p < 0.006). In the LAST group, a small but significant rise in troponin I concentration was noted at 4 hours (p <0.02), but the levels were considerably lower than in the control group and declined rapidly thereafter(Fig. 1).

View larger version (19K): [in this window] [in a new window]   Fig. 1. Troponin I release after coronary artery surgery. , Conventional CABG; , last operation.

References

1. Calafiore A, Angelini G. Left anterior small thoracotomy (LAST) for coronary artery revascularisation. Lancer 1996;347:263-4.
   
2. Westaby S, Benetti F. Less invasive coronary artery surgery: consensus from the Oxford meeting. Ann Thorac Surg 1996;62:924-31. [Free Full Text]
   
3. Etievent J, Chocron S, Toubin G, et al. Use of cardiac troponin I as a market of preioperative myocardial ischemia. Ann Thorac Surg 1995;59:1192-4.[Abstract/Free Full Text]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Birdi, I. Articles by Angelini, G. D. Search for Related Content PubMed PubMed Citation Articles by Birdi, I. Articles by Angelini, G. D.