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Revascularization of dysfunctional but viable myocardium needs to be careful about postoperative rhythm disturbance after off-pump coronary artery bypass grafting: an uncontrolled observational retrospective clinical study
Med Biol Sci Eng 2018;1(2):39-44
Published online July 31, 2018
© 2018 Medical Biological Science and Engineering.

Seong Hyop Kim1, Seung Zhoo Yoon2 , Kyung Hee Koh2, Jung Man Lee3

1Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, 2Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, 3Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Seung Zhoo Yoon
Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
Tel: +82-2-920-5632
Fax: +82-2-929-2936
Received April 30, 2018; Revised May 12, 2018; Accepted May 14, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Myocardial viability is one of important factors to determine clinical outcomes after off-pump coronary artery bypass grafting. We hypothesized that the revascularization of nonviable myocardium might show the different features of myocardial reperfusion postoperatively as compared with viable myocardium. Patients who underwent off-pump coronary artery bypass grafting for 2 years were retrospectively reviewed. Viable group (V group, n=159) and nonviable group (N group, n=24) were divided using preoperative single photon emission-computed tomography. The postoperative complication was evaluated by 1) occurrence of rhythm disturbance (atrial fibrillation/flutter or ventricular tachycardia), 2) use of continuous epinephrine, and 3) intra-aortic balloon pump insertion. Intubation time and intensive care unit (ICU) stay were also documented. Demographic data (gender, age, ejection fraction, and New York Heart Association [NYHA] classification) showed no difference. N group showed higher incidence of rhythm disturbance. Although intubation time showed no difference, ICU stay of N group was longer than V group. Revascularization of non-myocardium was associated with higher incidence of rhythm disturbance and longer ICU stay as compared with viable myocardium.
Keywords : Coronary artery bypass; Myocardial reperfusion; Postoperative complications
  1. Rizzello V, Poldermans D, Biagini E, Kertai MD, Schinkel AF, Boersma E, et al. Comparison of long-term effect of coronary artery bypass grafting in patients with ischemic cardiomyopathy with viable versus nonviable left ventricular myocardium. Am J Cardiol 2004;94:757-60.
    Pubmed CrossRef
  2. Rizzello V, Poldermans D, Biagini E, Schinkel AF, Elhendy A, Leone AM, et al. Relation of improvement in left ventricular ejection fraction versus improvement in heart failure symptoms after coronary revascularization in patients with ischemic cardiomyopathy. Am J Cardiol 2005;96:386-9.
    Pubmed CrossRef
  3. Lee KS, Marwick TH, Cook SA, Go RT, Fix JS, James KB, et al. Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization. Circulation 1994;90:2687-94.
    Pubmed CrossRef
  4. Gioia G, Powers J, Heo J, Iskandrian AS. Prognostic value of rest-redistribution tomographic thallium-201 imaging in ischemic cardiomyopathy. Am J Cardiol 1995;75:759-62.
  5. Di Carli MF, Davidson M, Little R, Khanna S, Mody FV, Brunken RC, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994;73:527-33.
  6. Rahimtoola SH. The hibernating myocardium. Am Heart J 1989;117:211-21.
  7. Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982;66:1146-9.
    Pubmed CrossRef
  8. Kang WJ, Lee DS, Paeng JC, Kim KB, Chung JK, Lee MC. Prognostic value of rest (201)Tl-dipyridamole stress (99m)Tcsestamibi gated SPECT for predicting patient-based clinical outcomes after bypass surgery in patients with ischemic left ventricular dysfunction. J Nucl Med 2003;44:1735-40.
  9. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-67.
  10. Trost JC, Hillis LD. Intra-aortic balloon counterpulsation. Am J Cardiol 2006;97:1391-8.
    Pubmed CrossRef
  11. Christenson JT, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg 1997;11:1097-103;discussion 1104.
  12. Kalman JM, Munawar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg 1995;60:1709-15.
  13. Nikolic G. Definition of ventricular tachycardia. Am J Cardiol 1982;50:1197-8.
  14. De Hert SG, Van der Linden PJ, Cromheecke S, Meeus R, ten Broecke PW, De Blier IG, et al. Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass. Anesthesiology 2004;101:9-20.
    Pubmed CrossRef
  15. Schelbert HR. Metabolic imaging to assess myocardial viability. J Nucl Med 1994;35(4 Suppl):8S-14S.
  16. Bergmann SR. Use and limitations of metabolic tracers labeled with positron-emitting radionuclides in the identification of viable myocardium. J Nucl Med 1994;35(4 Suppl):15S-22S.
  17. Jennings RB, Sommers HM, Smyth GA, Flack HA, Linn H. Myocardial necrosis induced by temporary occlusion of a coronary artery in the dog. Arch Pathol 1960;70:68-78.
  18. Lauer MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis 1989;31:367-78.
  19. Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 1997;226:501-11; discussion 511-3.
    Pubmed CrossRef
  20. Khabbaz KR, DeNofrio D, Kazimi M, Carpino PA. Revascularization options for ischemic cardiomyopathy: on-pump and off-pump coronary artery bypass surgery. Cardiology 2004;101:29-36.
    Pubmed CrossRef

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