Analysis of coronary endothelial damage and other adverse effects during off-pump CABG

虽然非体外循环冠状动脉旁路移植术（CABG）已被公认为比传统的CABG在体外循环下的创伤小，但非体外循环CABG可能是部分创伤性的，特别是对冠状动脉内皮。本研究旨在评价非体外循环冠状动脉旁路移植术的相关不良反应。冠状动脉圈套导致冠状动脉内皮损伤，使用弹性缝线代替非弹性缝线可改善冠状动脉内皮损伤。随着时间的推移，非湿化气体使血细胞沉积，内皮细胞分层。加湿气体吹入减弱了这些不良反应。肝素和潘生丁湿化在减少内皮细胞沉积方面具有潜在的优势。关于与冠状动脉暂时夹闭相关的分子生物学不良反应，在非体外循环CABG动物模型中，即使在短期缺血中也检测到NF-κ B。本研究还应用心脏内窥镜和数字化三维超声测微仪对犬非体外循环冠状动脉旁路移植术（CABG）中二尖瓣返流（MR）进行了研究，重点关注二尖瓣环的行为。只有心脏移位不会导致MR，如果冠状动脉灌注保持。LAD闭塞很少引起前外侧部位的MR。LCx闭塞通常主要引起后内侧部位MR，后内侧瓣环扩大，即使LVEDP得到控制。

Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects related to off-pump CABG.Coronary snaring resulted in coronary endothelial injury, which was ameliorated by using elastic sutures in stead of non-elastic sutures. Non-humidified gas insufflation made blood cells deposited and endothelial cells delaminated with time. Humidified gas insufflation attenuated these adverse effects. Heparin and dipyridamole-added humidification had potential advantage in terms of reducing deposited blood cells on the endothelium over simple humidification.Regarding molecular biological adverse effects related to temporary clamping of the coronary artery, NF-kB was detected even in the short term ischemia in animal model of off-pump CABG. These analysis are still on going.Mitral regurgitation (MR) during off-pump CABG, particularly focused on the mitral annular behavior, was also evaluated in dog by cardiac endoscopy and digital 3-D ultrasound sonomicrometer. Only cardiac displacement did not cause MR if coronary perfusion was maintained. Occlusion of LAD rarely caused MR from antero-lateral site. Occlusion of LCx usually caused MR from mainly postero-medial site with enlarged postero-medial annulus even with controlled LVEDP.