Şahinalp Şahin, Temiztürk Zeki, Çeviker Kadir, Özışık Kanat, Kızıltepe Uğursay
Department of Cardiovascular Surgery, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey.
Department of Cardiovascular Surgery, Elazig Education and Research Hospital, University of Health Sciences, Elazig, Turkey.
Braz J Cardiovasc Surg. 2020 Dec 1;35(6):906-912. doi: 10.21470/1678-9741-2019-0467.
To investigate the correlation between cardiac output values and renal neutrophil gelatinase-associated lipocalin (NGAL) levels as a biomarker of renal ischemia.
Forty patients, who underwent off-pump coronary artery bypass (OPCAB) surgery and in whom the positioning of the heart was fixed with simple suspension sutures without a mechanical stabilizer, were included in the study. Continuous cardiac output (CO) measurements were recorded using the arterial pressure waveform analysis method (FloTrac sensor system) in the perioperative period. CO was recorded every minute during non-anatomical cardiac positioning for left anterior descending artery (LAD), diagonal artery (D), circumflex artery (Cx), and right coronary artery (RCA) bypasses. Serum NGAL samples were analyzed in the preoperative, perioperative, and postoperative periods.
The CO values measured at various non-anatomical cardiac positions during distal anastomosis for LAD, D, Cx, and RCA were significantly lower than pre- and postoperative values measured with the heart in normal anatomical position (3.45±0.78, 2.9±0.71, 3.11±0.56, 3.19±0.81, 5.03±1.4, and 4.85±0.78, respectively, P=0.008). There was no significant difference between CO values measured at various non-anatomical cardiac positions during distal anastomosis. Although there was no significant correlation between NGAL levels and age, duration of surgery, preoperative CO, D-CO, RCA-CO, and postoperative CO measurements, there was a significant correlation between NGAL levels and LAD-CO (P=0.044) and Cx-CO (P=0.018) at the postoperative 12th hour.
Full revascularization may be achieved by employing the OPCAB technique while using simple suspension sutures without a mechanical stabilizer and by providing safe CO levels and low risk of renal ischemia.
探讨心输出量值与肾中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平之间的相关性，NGAL作为肾缺血的生物标志物。
本研究纳入40例行非体外循环冠状动脉搭桥术（OPCAB）的患者，这些患者心脏定位采用简单悬吊缝线固定，未使用机械稳定器。围手术期采用动脉压波形分析法（FloTrac传感器系统）记录连续心输出量（CO）。在左前降支（LAD）、对角支（D）、回旋支（Cx）和右冠状动脉（RCA）搭桥的非解剖学心脏定位期间，每分钟记录一次CO。在术前、围手术期和术后分析血清NGAL样本。
在LAD、D、Cx和RCA远端吻合期间，在不同非解剖学心脏位置测量的CO值显著低于心脏处于正常解剖位置时术前和术后测量的值（分别为3.45±0.78、2.9±0.71、3.11±0.56、3.19±0.81、5.03±1.4和4.85±0.78，P=0.008）。在远端吻合期间，不同非解剖学心脏位置测量的CO值之间无显著差异。虽然NGAL水平与年龄、手术时间、术前CO、D-CO、RCA-CO和术后CO测量值之间无显著相关性，但在术后第12小时，NGAL水平与LAD-CO（P=0.044）和Cx-CO（P=0.018）之间存在显著相关性。
采用OPCAB技术，在不使用机械稳定器的情况下使用简单悬吊缝线，并提供安全的CO水平和低肾缺血风险，可能实现完全血运重建。
