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Intracoronary shunt reduces postoperative troponin leaks: a prospective randomized study
Ali Gürbüz1, Bilgin Emrecan, Levent Yilik
1Department of Cardiovascular Surgery, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
Insights
Intracoronary shunts significantly reduced postoperative troponin I levels in off-pump coronary artery bypass grafting (OPCABG) surgery for left anterior descending artery lesions, suggesting their benefit in preventing myocardial damage.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Off-pump coronary artery bypass grafting (OPCABG) aims to reduce myocardial damage.
- The use of intracoronary shunts during OPCABG is debated for its efficacy in minimizing myocardial injury.
Purpose of the Study:
- To compare the effectiveness of intracoronary shunt usage versus a shuntless technique in reducing myocardial damage during OPCABG for isolated left anterior descending artery lesions.
- To evaluate differences in cardiac markers between the two surgical approaches.
Main Methods:
- Forty patients with stable angina and isolated LAD lesions were randomized into two groups: shunt (n=20) and shuntless (n=20).
- Both groups underwent OPCABG surgery.
- Cardiac troponin I, CK, and CK-MB levels were measured preoperatively and 24 hours postoperatively.
Main Results:
- No significant differences in preoperative or postoperative CK and CK-MB levels were observed between the groups.
- Postoperative troponin I levels were significantly higher in the shuntless group compared to the shunt group (p=0.003).
- The duration of LIMA-LAD anastomosis was longer in the shunt group (p=0.01).
Conclusions:
- Intracoronary shunts significantly reduce postoperative troponin I levels in OPCABG for LAD lesions.
- The use of intracoronary shunts may be beneficial for patients at risk of transient myocardial ischemia during OPCABG.
- This technique could be indicated to minimize myocardial damage in specific patient populations.
Objective:
The purpose of this study was to evaluate whether intracoronary shunt usage reduced the myocardial damage on the basis of the cardiac markers when compared with the shuntless anastomosis in off-pump coronary artery bypass grafting (OPCABG) surgery of isolated left anterior descending artery lesions.
Methods:
Forty patients who had stable angina with isolated left anterior descending (LAD) coronary artery lesion undergoing OPCABG surgery were randomized into two groups. Shunt group consisted of 20 patients who had OPCABG using intracoronary shunt, whereas the shuntless group consisted of 20 patients who underwent OPCABG without using intracoronary shunt. Cardiac troponin I, CK, and CK-MB before and 24h after the surgery were assessed in the groups.
Results:
There were no deaths in the study. The two groups were similar with respect to sex and age. Duration of LIMA-LAD anastomosis was significantly higher in the shunt group (p=0.01). There was no significant difference between the groups concerning the preoperative and postoperative CK and CK-MB levels. The preoperative troponin I levels of the groups were not different (p=0.238; NS), whereas postoperative levels of this marker was significantly higher in the shuntless group (p=0.003).
Conclusion:
Intracoronary shunt reduced the postoperative troponin I levels significantly, so it may be indicated in the patients who are thought to be susceptible to transient ischemia.