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Published on: September 15, 2023
Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery
Jacob Bergsland1, Per Snorre Lingaas, Helge Skulstad
1The Interventional Centre, Rikshospitalet, University of Oslo, Oslo, Norway. nielsb@aol.com
Insights
Intracoronary shunts effectively prevent myocardial ischemia during off-pump coronary artery bypass surgery. This technique ensures excellent graft patency and reduces the risk of ischemia in patients undergoing bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Surgical Innovation
- Myocardial Protection
Background:
- Off-pump coronary artery bypass (OPCAB) surgery aims to reduce myocardial injury.
- The use of intracoronary shunts during OPCAB is debated.
- Monitoring ischemia during grafting is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of intracoronary shunts in preventing ischemia during OPCAB.
- To assess the impact of shunts on graft patency and patient outcomes.
Main Methods:
- A randomized trial of 56 patients undergoing OPCAB using the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery.
- Patients were assigned to receive either an intracoronary shunt or occlusive snaring.
- Ischemia was monitored using tissue Doppler, hemodynamic parameters, and angiography.
Main Results:
- Ischemia occurred in 26/33 non-shunted patients but not in those with retrograde filling.
- Shunts reversed ischemia in 14/16 patients, compared to 3/17 non-shunted patients (p=0.004).
- A trend towards improved on-table angiographic results was observed in shunted patients; 100% graft patency at 3 months.
Conclusions:
- Intracoronary shunts are effective in preventing myocardial ischemia during LAD grafting in OPCAB.
- The use of shunts ensures satisfactory immediate and short-term graft patency.
Background:
The purpose of this study was to evaluate the role of intracoronary shunt during off-pump coronary artery bypass surgery.
Methods:
Fifty-six patients undergoing off-pump coronary artery bypass using the left internal mammary artery to bypass the left anterior descending coronary artery were randomly assigned to have the bypass performed with intracoronary shunt or by occlusive snaring. Ischemia during grafting was monitored by tissue Doppler. Hemodynamic status and indicators of ischemia were monitored, and on-table and postoperative angiography were performed.
Results:
In patients with retrograde filling of the left anterior descending coronary artery, ischemia did not develop, but occlusion of antegradely perfused vessels caused ischemia in 26 of 33 patients. Ischemia was reversed in 14 of 16 shunted patients, and in 3 of 17 nonshunted cases (p = 0.004). Angiography showed a trend toward improved on-table angiographic results in shunted patients. After 3 months, graft patency was 100%, but 1 patient treated without shunt required reintervention and 15 patients had new angiographic lesions, equally distributed between shunted and nonshunted patients.
Conclusions:
Intracoronary shunt prevents ischemia during grafting of the left anterior descending coronary artery and provides satisfactory immediate- and short-term graft patency.
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