Perfusion flow assessment of coronary shunt during off-pump coronary artery bypass grafting

Coronary shunts are widely used to prevent myocardial ischemia during off-pump coronary artery bypass graft (OPCAB) procedures. Although clinical effectiveness has been reported, actual perfusion flow has not been well assessed. The purpose of this study was to evaluate actual shunt flow and its pattern during passive coronary perfusion in clinical OPCAB.

In 15 OPCAB cases, the coronary perfusion flow of the external shunt (1.7 or 2.0 mm) during anastomosis and the free flow of the shunt were measured with an in-line electromagnetic or ultrasonic flow probe. The perfused coronary blood vessel was either the left anterior descending coronary artery or the right coronary artery. The inflow vessel of the external shunt was either the femoral artery (FA) or the ascending aorta (AA).

Free flow values of a 1.7-mm FA shunt, 1.7-mm AA shunt, and 2.0-mm FA shunt were 34+/- 7, 39 +/- 3, and 44 +/- 7 mL/min. Perfusion flows were 13 +/- 4, 14 +/- 3, and 22 +/- 4 mL/min, respectively. Perfusion flow was significantly lower than free flow and correlated well with coronary resistance. Although inflow site did not influence net perfusion flow, diastolic/systolic flow fraction ratio was significantly greater when the shunt was perfused from the FA.

External shunt from FA would provide limited but effective perfusion flow with a physiological pattern, which is passively regulated by coronary resistance.