| Objective: Coronary atherosclerotic cardiovascular disease is a general term for a group of diseases that cause myocardial damage due to inadequate blood supply to the coronary arteries.Coronary artery bypass grafting is a major treatment for coronary artery disease,however,surgical revascularization may lead to myocardial injury or postoperative myocardial infarction.Studies have reported an increased risk of nonfatal myocardial infarction and death in patients with elevated postoperative troponin.Therefore,the aim of this study was tantamount to investigate the association between the use of intraoperative transit time flow measurement in offpump circulation coronary artery bypass grafting and postoperative myocardial injury.Methods: In this retrospective study,we collected basic information,surgical conditions,procedures for the use of TTFM and markers of postoperative myocardial injury in patients hospitalized for off-pump circulation coronary artery bypass grafting in the Department of Cardiothoracic Surgery,Changzhou Second People’s Hospital.From June 2016 to June 2021 affiliated with Nanjing Medical University.Patients were grouped according to TTFM use and analysis began in December 2022.Based on the ACR-2 definition of significant myocardial injury,we used troponin I(c TNI)>2380 ng/L as a criterion for postoperative significant myocardial injury,and this criterion mainly utilized troponin as a study index without considering electrocardiographic or imaging manifestations of myocardial ischemia.We evaluated the association of TTFM use with myocardial injury outcomes using Logisitic regression,and also correlated intraoperative measurements of blood flow with postoperative troponin,cardiac enzymes,and other indicators of myocardial injury.We have a hospital-based follow-up system that is implemented by nurses every 6 months and 1-year,and in addition,we retrieve patients’ records from outpatient visits to comparative verification and supplementation.For the patients who were not followed by nurses,we counted them and followed them up by telephone on September 1,2022.We excluded patients who were lost to follow-up and those who were followed up for less than one year from the prognostic analysis.We further evaluated whether the use of intraoperative TTFM was beneficial in terms of 1-year survival by following up on patient survival and graft vessel patency.Results: A total of 146 patients were entered in this study,of whom 80(54.80%)received TTFM and 66(45.20%)did not.The overall median age of these patients was 65.05 years,and 32(21.92%)experienced postoperative myocardial injury.TTFM was independently associated with the incidence of postoperative myocardial injury(odds ratio [OR],0.34 [ 95% CI,0.15-0.78];P =.01),and we found similar trends in regression analyses for sex,age,number of graft vessels,hypertension,diabetes,BMI,and PCI subgroups.In addition,the number of graft vessel anastomoses(OR,1.52 [95% CI,1.01-2.32];P =.05)and hypertension(OR,6.42 [95% CI,1.49-46.24];P =.03)were related to the occurrence of postoperative myocardial injury,respectively.A total of 106 patients were followed for 1-year vascular permeability,of whom 7 patients(6.6%)experienced graft vessel obstruction.We also did not conclude a correlation between TTFM measures and markers of postoperative myocardial injury.Conclusion: The use of TTFM during off-pump circulation coronary artery bypass surgery was independently associated with a reduction in the occurrence of postoperative myocardial lesions,Especially in patients of advanced age(>65 years),in male patients,in patients with combined hypertension and in patients with a higher number of bypasses(> = 3).TTFM procedures in off-pump circulation coronary artery bypass grafting deserve to be actively promoted to decrease the incidence of postoperative myocardial injury.At the same time,we did not find any correlation between the relevant tests of TTFM(pulsatility index,mean flow,diastolic filling)and myocardial injury indicators(P>0.05),which suggests that we do not need to change the current measurement criteria. |
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