Early Graft Reperfusion and Arrhythmias After Coronary Artery Bypass Grafting.

Background Arrhythmia after coronary artery bypass grafting (CABG) may occur immediately after the abrupt onset of reperfusion via all coronary bypass grafts simultaneously. We investigated whether early reperfusion of the left anterior descending coronary artery before weaning from cardiopulmonary bypass would decrease the frequency of early arrhythmias after CABG. We compared patients undergoing release of the left internal thoracic artery (LITA) graft flow before versus after aortic declamping during CABG. Methodology In total, 109 consecutive patients undergoing CABG were retrospectively analyzed. The heart rhythms after CABG of 46 patients with flow release from LITA before aortic declamping (study group) were compared with 63 patients with complete onset of reperfusion of all coronary bypass grafts simultaneously after aortic declamping (controls). Early arrhythmias were recorded and included atrial fibrillation, ventricular tachycardia, ventricular fibrillation, and arrhythmias necessitating temporary pacemaker support. Results Early arrhythmias occurred in seven out of 46 study group patients with the early release of LITA graft flow compared with 21 out of 63 controls (15.2% vs. 33.3%, p = 0.033). Creatine kinase-myocardial band levels were lower in the study group than in the controls (27.5 ± 58.4 vs. 33.0 ± 48.0, p = 0.004, respectively). Sinus rhythm was achieved in all but three patients before extubation including two in the study group and one in the controls. Conclusions The simple maneuver of releasing LITA graft flow before aortic declamping during CABG allows gradual reperfusion of the myocardium and may ensure early rhythm control.

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Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of the Tampere University Hospital, Tampere, Finland issued approval R23028. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.