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

尽管体外循环非体外循环冠状动脉旁路移植术（CABG）的侵入性比传统的冠状动脉旁路移植术小，但非体外循环冠状动脉旁路移植术可能有部分侵入性，尤其是对冠状动脉内皮。本研究旨在评估非泵送冠脉搭桥相关的不良反应。冠状动脉陷阱导致冠状动脉内皮损伤，使用弹性缝合线代替非弹性缝合线可以改善这种损伤。无湿充气使血细胞沉积，内皮细胞随时间分层。加湿气体的充气减轻了这些不利影响。肝素和双嘧达莫加湿在减少内皮细胞沉积方面比简单加湿有潜在的优势。对于暂时夹持冠状动脉相关的分子生物学不良反应，在非泵送冠状动脉搭桥动物模型中，即使在短期缺血中也检测到NF-kB。这些分析仍在进行中。通过心脏内窥镜和数字3-D超声声微米计对狗在非泵送冠状动脉搭桥期间的二尖瓣反流（MR）进行了评估，特别是对二尖瓣环的行为进行了评估。如果冠状动脉灌注维持，只有心脏位移不会引起MR。LAD闭塞很少引起前外侧部位的MR。即使在控制LVEDP的情况下，LCx闭塞通常也会引起MR主要来自后内侧部位，后内侧环增大。

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.