Original articleAdult cardiacIntracoronary Shunt Prevents Ischemia in Off-Pump Coronary Artery Bypass Surgery
Section snippets
Material and Methods
Patients scheduled for OPCABG were randomly assigned to two groups. In the no-shunt group, left internal mammary artery (LIMA) grafting to the LAD was performed with proximal occlusion. In the shunt group, an intracoronary shunt was utilized. Transesophageal ultrasonography with tissue Doppler was used to detect ischemia in the interventricular septum. Potential damage from the shunt or from snaring was monitored by clinical follow-up, monitoring of cardiac enzymes, electrocardiography (ECG),
Results
Twenty-seven patients were randomly assigned to shunt and 29 to no shunt. There were no differences between groups with regard to demographics or risk factors, except for more smokers in the shunt group (Table 1). In 3 patients, shunt insertion was unsuccessful, and the graft was performed as in the no-shunt group. Two shunts had a diameter of 1.25 mm, 14 had a diameter of 1.50 mm, 7 had a diameter of 1.75 mm, and 1 had a diameter of 2.00 mm. All no-shunt patients were treated without shunt.
Comment
Technical improvements have made OPCABG a more attractive option for coronary revascularization than when described by Kolesov [22] in the 1960s. The OPCABG surgeon still occasionally faces myocardial ischemia and hemodynamic collapse during surgery. An intracoronary shunt may prevent such events and the need for emergency initiation of CPB [2, 23] and help the surgeon to perform a better anastomosis. It is possible, however, that a shunt may denude the endothelium and cause vessel damage,
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Cited by (29)
New approaches to cardiovascular surgery
2014, Current Problems in CardiologyCitation Excerpt :Target vessels must be isolated and blood flow controlled to allow sufficient visualization for sewing. Intracoronary shunts are used to circumvent the transient occlusion of the coronary allowing distal coronary perfusion (Fig 1).4,5 As experience increases, surgeons who perform OPCAB often liberalize the criteria for patients who may benefit from OPCAB.6
Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting
2014, Journal of Thoracic and Cardiovascular SurgeryAnesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB)
2013, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Left ventricular segmental wall motion abnormalities also occur during target-vessel occlusion in beating-heart TECAB. Selective use of a shunt for open, off-pump CABG, when myocardial ischemia is detected, protects against infarction.38,39 In TECAB, use of the same may resolve ischemia detected by either regional wall motion abnormalities on TEE or ST-segment changes on ECG.
Meta-analysis of organ damage after conversion from off-pump coronary artery bypass procedures
2011, Annals of Thoracic SurgeryCitation Excerpt :Most of the included studies mention an “ischemia-hypotension” phenomenon as the main reason for emergency conversion. The importance of myocardial protection in OPCAB surgery including the use of coronary shunts [35] and selection of the ideal grafting sequence [36] has been highlighted before. However, above all the formation of a secure, leak-proof anastomosis is the most important factor and this is surgeon dependent [37].
Conversion and safety in off-pump coronary artery bypass: A system failure that needs re-emphasis
2011, Annals of Thoracic SurgeryCitation Excerpt :Their association with conversion, and any role they may have in its prevention, has not been formally investigated. However, in a recent randomized study, Bergsland and colleagues [45] demonstrated that use of intracoronary shunts could significantly reverse the ischemia in LAD vessels with anterograde filling that were being proximally occluded during grafting. Reduction in postoperative troponin I release [46], reduced echocardiographic evidence of acute ischemia, and improved graft patency [47] have also been reported with intracoronary shunts.
Reply
2010, Annals of Thoracic Surgery