The correlation of akinesia with graft patency and cardiac enzyme after off-pump coronary artery bypass graft surgery

Abstract

The purpose of this study is to identify the clinical implications of newly developed akinesia in echocardiography after off-pump CABG and its relationship with graft patency. 512 patients underwent off-pump CABG from January 2007 to November 2008. 239 patients, whose echocardiography and multislice CT data are available, were included in this study. Wall motion was subdivided into 16 segments and analyzed. Patients were separated into Group A with newly developed akinesia (n=20) and Group B without newly developed akinesia (n=219). Morbidity and early mortality, cardiac enzyme level, and graft patency were compared. The incidence of newly developed akinesia according to the anatomical territory was as follows: anterior, 5; lateral, 3; posterior, 7; and multiple territories, 5. Significant differences in preoperative ejection fraction were observed between the two groups (A: 45.0±7%, B: 58.0±12.2%, p<0.001). There was no statistical difference in the mean number of bypassed grafts and the complete revascularization rate. Complication and early mortality rates were insignificant between the two groups. There was little association between graft patency, cardiac enzyme level, and newly developed akinesia (p>0.05). Multivariate analysis showed that the preoperative ejection fraction was a risk factor for newly developed akinesia. The mechanism of akinesia developing after off-pump CABG might be attributable to intraoperative coronary malperfusion which is probably due to cardiac manipulation rather than graft occlusion.