Risk factors of ischemic-reperfusion myocardial injury during coronary artery bypass grafting

Modern cardiac surgery has made significant advances in the treatment of coronary artery disease. Despite the high effectiveness of treatment, interventional techniques, however, suggest a potential risk of complications, reperfusion injury playing a significant role in this.

The aim of the study was to identify risk factors influencing the development of ischemia-reperfusion myocardial injury during cardiac surgery in patients with coronary heart disease.

Materials and Methods. This prospective study included 162 patients, of whom 25 patients (15.4%) underwent off-pump coronary artery bypass grafting, 81 patients (50%) survived on-pump coronary artery bypass grafting and 56 patients (34.6%) underwent mitral and/or tricuspid valve repair or replacement in addition to myocardial revascularization. Ischemia-reperfusion injury was observed in 58 (35.8%) patients. All patients underwent echocardiography, coronary angiography, magnetic resonance imaging and a comprehensive clinical and laboratory analysis, including markers of cardiovascular risk.

Results: The study revealed that risk factors influencing the development of ischemia-reperfusion myocardial injury, both during cardiac surgery using artificial circulation and during coronary artery bypass grafting on a beating heart, are the left ventricular myocardial mass index (r = 0.75; p = 0.01; r = 0.68; p < 0.05, respectively), points on the SYNTAX Score scale (r = 0.7; p = 0.01; r = 0.56; p < 0.05, respectively), as well as the initial level of high-sensitivity troponin I (r = 0.88; p = 0.001; r = 0.71; p = 0.01; respectively). Intraoperative risk factors for the development of myocardial reperfusion injury include the duration of myocardial ischemia (r = 0.65, p < 0.05) and the duration of artificial circulation (r = 0.72; p = 0.01) during cardiac surgery using artificial circulation.

Thus, a number of risk factors influencing the development of myocardial ischemia-reperfusion disorders during cardiac surgery were established.

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