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["Off-pump" myocardial revascularization: experience in the Clinic of Cardiosurgery, Kaunas University of Medicine].

UNLABELLED
According to indications there is no difference in results of grafts patency and left ventricle function after minimal invasive myocardial revascularization in comparison to typical operation with cardiopulmonary bypass and cardioplegia. Only ranges of troponin T (TnT), CK and CK-MB are statistically significantly lower in the group of operations without cardiopulmonary bypass and cardioplegia.


MATERIAL AND METHODS
According to possibilities different surgical technic of minimally invasive myocardial revascularization was used in 119 patients with chronic ischemic heart disease. Dynamic perioperative level of cardiospecific agents (TnT, CK, CK-MB) was determined in 30 cases; left ventricle function was echoscopically analyzed (ejection fraction, left ventricle wall motion index, left ventricle end diastolic diameter) for 70 patients and postoperative angiographic control was done for 46 patients.


RESULTS
All operations were done in the Clinic of Cardiosurgery of Kaunas University of Medicine until July 1, 2003. An analysis of operative data of 119 cases with ischemic heart disease is presented. All patients underwent thoracic coronary and aortocoronary bypass grafting using minimal invasive cardiosurgical technique on the beating heart without cardiopulmonary bypass ("off-pump"). In most cases median sternotomy was used. Left internal thoracic artery or saphenous vein were applied as a grafts. Perioperative investigation of TnT, CK and CK-MB for 30 patients in early postoperative period showed low level of signs of myocardial injury. Postoperative angiographic control of grafts in 46 patients was done until 30(th) postoperative day and showed excellent patency rate of arterial and vein bypasses. In cases of complete revascularization marked and statistically significant improvement of the left ventricle function was found.


CONCLUSIONS
According to indications minimally invasive ("off-pump") operation is alternative method to traditional myocardial revascularization with cardiopulmonary bypass and cardioplegia. In these cases lower level of perioperative myocardial injury is observed; improvement of left ventricle function and high postoperative graft patency are similar to those after traditional operations.