Evaluation of Left Ventricular Myocardial Work Performance in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery.

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Tytuł:: Evaluation of Left Ventricular Myocardial Work Performance in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery.
Autorzy:: Spetsotaki K; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Zayat R; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Donuru S; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Autschbach R; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Schnoering H; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Hatam N; Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Źródło:: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia [Ann Thorac Cardiovasc Surg] 2020 Oct 21; Vol. 26 (5), pp. 276-285. Date of Electronic Publication: 2020 Sep 07.
Typ publikacji:: Comparative Study; Journal Article; Observational Study
Język:: English
Imprint Name(s):: Original Publication: Tokyo : Japanese Editorial Committee of Annals of Thoracic and Cardiovascular Surgery,
MeSH Terms:: Cardiopulmonary Bypass*/adverse effects
Coronary Artery Bypass*/adverse effects
Coronary Artery Bypass, Off-Pump*/adverse effects
Myocardial Contraction*
Ventricular Function, Left*
Coronary Artery Disease/*surgery
Aged ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/physiopathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology
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Contributed Indexing:: Keywords: echocardiography; global myocardial work; left ventricular systolic function; non-invasive; off-pump coronary surgery
Entry Date(s):: Date Created: 20200907 Date Completed: 20201110 Latest Revision: 20210111
Update Code:: 20240104
PubMed Central ID:: PMC7641886
DOI:: 10.5761/atcs.oa.20-00066
PMID:: 32893224
: Czasopismo naukowe

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Purpose: Benefits of off-pump coronary bypass (OPCAB) over on-pump (ONCAB) remain controversial. We aimed to evaluate the early impacts of OPCAB vs ONCAB for varying left ventricular (LV) function baselines by applying the non-invasive myocardial work (MW) analysis, which enables further insights in cardiac mechanics, contractility, and efficacy.
Methods: We retrospectively analyzed 98 patients (55 ONCAB vs 43 OPCAB). Transthoracic echocardiography (TTE) and concurrent arterial blood pressure measurements taken at rest, prior to, and early after surgery were performed. Global myocardial work index (GMWI), global constructive work (GCW), and global work efficiency (GWE), inter alia, were quantified.
Results: Preoperatively, OPCAB patients had significantly lower values than ONCAB patients in terms of GMWI (1404.33 ± 585.41 mmHg% vs 1619.07 ± 535.42 mmHg%, p = 0.039), GWE (90% (60%, 96%) vs 93% (74%, 98%), p = 0.028). After surgery, GMWI was reduced in both groups. However, a more significant GMWI impairment occurred early after ONCAB than after OPCAB (-343.14 ± 35.20 mmHg%, p <0.001 vs -224.04 ± 120.91 mmHg%, p = 0.042).
Conclusion: Despite lower preoperative LV function in OPCAB patients, GMWIs after OPCAB were superior to ONCAB, indicating better preservation of systolic LV function early after OPCAB by means of contractility compared to ONCAB. Further studies should investigate the long-term course of MW response and their clinical impact.

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