Graft preservation confers myocardial protection during coronary artery bypass grafting

Philipp Szalkiewicz; Maximilian Y Emmert; Paul P Heinisch; Zsuzsanna Arnold; Ingo Crailsheim; Markus Mach; Thomas Aschacher; Martin Grabenwöger; Bernhard Winkler

doi:10.3389/fcvm.2022.922357

Graft preservation confers myocardial protection during coronary artery bypass grafting

Front Cardiovasc Med. 2022 Jul 28:9:922357. doi: 10.3389/fcvm.2022.922357. eCollection 2022.

Authors

Philipp Szalkiewicz¹, Maximilian Y Emmert^{2

3}, Paul P Heinisch⁴, Zsuzsanna Arnold^{1

5}, Ingo Crailsheim^{1

5}, Markus Mach^{6

7}, Thomas Aschacher^{1

5

6}, Martin Grabenwöger^{1

5

8}, Bernhard Winkler^{1

5

6}

Affiliations

¹ Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria.
² Deutsches Herzzentrum Berlin, Berlin, Germany.
³ Clinic for Cardiovascular Surgery, Charité University Medicine Berlin, Berlin, Germany.
⁴ German Heart Centre Munich, Technical University Munich, Munich, Germany.
⁵ Vienna Health Association, Vienna, Austria.
⁶ Medical University of Vienna, Vienna, Austria.
⁷ Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria.
⁸ Sigmund Freud University Vienna, Vienna, Austria.

Abstract

Background: During on-pump coronary artery bypass grafting (ONCAB), graft flushing for distal anastomoses testing also perfuses the downstream myocardium. This single-center retrospective study evaluated the impact of specific preservation solutions on myocardial protection during ONCAB.

Materials and methods: Between July 2019 and March 2020 either DuraGraft (DG) or 0.9% Saline/Biseko (SB) was applied to 272 ONCAB. Overall, 166 patients were propensity-matched into two groups. Cardiac enzymes [high-sensitive Troponin I (hs-TnI) and creatine kinase (CK)] were evaluated 7 days post-surgery.

Results: Post-surgery, hs-TnI values were significantly lower from 3 to 6 h (h) up to 4 days in the DG group: 3-6 h: 4,034 ng/L [IQR 1,853-8,654] vs. 5,532 ng/L [IQR 3,633-8,862], p = 0.05; 12-24 h: 2,420 ng/L [IQR 1,408-5,782] vs. 4,166 [IQR 2,052-8,624], p < 0.01; 2 days: 1,095 ng/L [IQR 479-2,311] vs. 1,564 ng/L [IQR 659-5,057], p = 0.02 and at 4 days: 488 ng/L [IQR 232-1,061] vs. 745 ng/L [IQR 319-1,820], p = 0.03. The maximum value: 4,151 ng/L [IQR 2,056-8,621] vs. 6,349 ng/L [IQR 4,061-12,664], p < 0.01 and the median area under the curve (AUC): 6,146 ng/L/24 h [IQR 3,121-13,248] vs. 10,735 ng/L/24 h [IQR 4,859-21,484], p = 0.02 were lower in the DG group. CK values were not significantly different between groups: maximum value 690 [IQR 417-947] vs. 631 [464-979], p = 0.61 and AUC 1,986 [1,226-2,899] vs. 2,081 [1,311-3,063], p = 0.37.

Conclusion: Repeated graft flushing with DG resulted in lower Troponin values post-surgery suggesting enhanced myocardial protection compared to SB. Additional studies are warranted to further assess the myocardial protection properties of DG.

Keywords: coronary artery; myocardium; protection; storage solutions; vein graft preservation.