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Effects on coronary endothelial function of the Cohn stabilizer for beating heart bypass operations
L P Perrault1, C Nickner, N Desjardins
1Research Center and Department of Surgery, Montreal Heart Institute, Quebec, Canada. lpperrau@icm.umontreal.ca
Insights
The Cohn stabilizer better preserves coronary endothelial function during beating heart coronary artery bypass grafts (CABG) compared to coronary shunts. This suggests improved outcomes for CABG procedures using the Cohn stabilizer.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Techniques
Background:
- Minimally invasive beating heart coronary artery bypass grafts (CABG) require effective stabilization methods.
- The impact of different CABG stabilization techniques on coronary endothelial function remains unclear.
Purpose of the Study:
- To compare the effects of the Cohn stabilizer and a coronary shunt on endothelial function in a beating heart CABG model.
- To evaluate the preservation of endothelial coverage and function after device application.
Main Methods:
- Porcine epicardial coronary arteries were instrumented with either the Cohn stabilizer or a coronary shunt for 15 minutes.
- Endothelial function was assessed via organ chamber experiments measuring relaxation to serotonin and bradykinin (endothelium-dependent) and sodium nitroprusside (endothelium-independent).
- Endothelial coverage was evaluated using silver nitrate staining.
Main Results:
- Endothelium-dependent relaxation was significantly reduced in the coronary shunt group compared to the Cohn stabilizer, control, and snare groups.
- No significant differences in endothelium-independent relaxation were observed between any groups.
- Silver nitrate staining indicated better endothelial coverage with the Cohn stabilizer.
Conclusions:
- The Cohn stabilizer demonstrates superior preservation of endothelial function compared to coronary shunts in beating heart CABG.
- This suggests the Cohn stabilizer may reduce the risk of coronary spasm and subsequent intimal hyperplasia.
- Improved endothelial preservation highlights the Cohn stabilizer's potential benefit in CABG surgery.
Background:
The effects of different stabilizing methods for minimally invasive beating heart coronary artery bypass grafts (CABG) on coronary endothelial function are unknown.
Methods:
We compared the effects on endothelial function of the Cohn stabilizer (used with proximal snaring by Retract-o-tape silicone air cushion) and a coronary shunt (CTS flow coil shunt) on an in vivo model of beating heart CABG. The two techniques were applied for 15 minutes on porcine epicardial coronary arteries. Control rings were taken from the same coronary artery. Endothelial function of control and instrumented arterial rings was studied in organ chamber experiments. Evaluation of endothelial coverage was performed with silver nitrate staining.
Results:
Endothelium-dependent relaxation to serotonin and bradykinin was significantly decreased in the shunt group compared to control, Cohn stabilizer, and snare groups. There were no significant differences in the endothelium-independent relaxation to sodium nitroprusside between groups.
Conclusions:
Greater endothelium-dependent relaxation with the Cohn stabilizer suggests better preservation of endothelial coverage at the site of application and reduced propensity for coronary spasm and later development of intimal hyperplasia.