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

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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.