Bonatti J, Hangler H, Hörmann C, Mair J, Falkensammer J, Mair P
Department of Anesthesiology and General Intensive Care, University of Innsbruck, Austria.
Ann Thorac Surg. 1998 Sep;66(3):1093-6. doi: 10.1016/s0003-4975(98)00733-4.
In conventional coronary artery bypass grafting, the rate of perioperative myocardial infarction is reported in the 2% to 6% range; however, significantly higher rates are observed if sensitive myocardial marker proteins are used to detect perioperative myocardial damage. For minimally invasive direct coronary artery bypass grafting, few data are available concerning myocardial marker protein release.
Fifteen consecutive patients (11 male, 4 female; mean age, 59.6 +/- 8.5 years) received minimally invasive direct coronary artery bypass grafting procedures via minithoracotomy on the beating heart. Electrocardiography and transesophageal and transthoracic echocardiography as well as determination of creatine kinase-MB mass concentration and cardiac troponin I level were used for ischemic monitoring.
One patient had a perioperative myocardial infarction according to standard criteria and died despite mechanical circulatory support. Determination of cardiac troponin I level showed small but definitive ischemic damage in 4 of 9 patients (44%) who presented transient ischemic signs intraoperatively or postoperatively. In 2 of these 4 patients pathologic findings could be detected on angiographic restudies.
Subclinical myocardial injury is a common event in minimally invasive coronary artery bypass grafting on the beating heart. Cardiac troponin I could serve as an adequate diagnostic tool for diagnosis of perioperative myocardial infarction in minimally invasive direct coronary artery bypass grafting.
在传统冠状动脉旁路移植术中，围手术期心肌梗死发生率据报道在2%至6%之间；然而，如果使用敏感的心肌标志物蛋白来检测围手术期心肌损伤，观察到的发生率会显著更高。对于微创直接冠状动脉旁路移植术，关于心肌标志物蛋白释放的数据很少。
连续15例患者（11例男性，4例女性；平均年龄59.6±8.5岁）通过小切口开胸在跳动心脏上接受微创直接冠状动脉旁路移植手术。采用心电图、经食管和经胸超声心动图以及测定肌酸激酶-MB质量浓度和心肌肌钙蛋白I水平进行缺血监测。
1例患者根据标准标准发生围手术期心肌梗死，尽管接受了机械循环支持仍死亡。测定心肌肌钙蛋白I水平显示，9例术中或术后出现短暂缺血征象的患者中有4例（44%）存在轻微但明确的缺血损伤。在这4例患者中的2例，血管造影复查可检测到病理改变。
亚临床心肌损伤在跳动心脏的微创冠状动脉旁路移植术中是常见事件。心肌肌钙蛋白I可作为微创直接冠状动脉旁路移植术中围手术期心肌梗死诊断的合适诊断工具。
