[The effect of different coronary artery flow isolation techniques in off-pump coronary artery bypass grafting]

Objective: To explore the clinical effect of different coronary artery flow isolation methods in off-pump coronary artery bypass grafting (OPCABG). Methods: A total of 60 patients who accepted OPCABG in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from June 2021 to June 2024 were randomly divided into three groups by computer. The different coronary flow isolation methods were used in three groups. The coronary artery was occluded with tourniquets in the occlusion group (n=20). The coronary artery was shunted with shunt in the shunt group (n=20). The coronary artery was selectively shunted or occluded according to the different blood flow conditions of each target vessel in the combined group (n=20). The anastomosis time and the amount of bleeding were observed and compared. The serum levels of cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-ProBNP) were detected after eight hours of operation. Results: Among the 60 patients with coronary artery disease, 48 patients were male and 12 patients were female. The anastomotic time of each anastomosis in the shunt group was longer than that in the occlusion group and the combined group [(18.4±2.8) min vs (12.3±2.2) min, (14.3±2.9) min, both P<0.017]. There was no statistically significant difference in anastomotic time between the occlusion group and the combined group (P=0.176). Postoperative serum cTnT in the occlusion group was higher than that in the shunt group and the combined group [(0.28±0.07) μg/L vs (0.16±0.03) μg/L, (0.17±0.04) μg/L, both P<0.017]. There was no statistically significant difference in postoperative serum cTnT between the shunt group and the combined group (P=0.152). Postoperative serum NT-ProBNP in the combined group was lower than that in the occlusion group and the shunt group [(254±27) ng/L vs (481±19) ng/L, (373±42) ng/L, both P<0.017]. Postoperative serum NT-ProBNP in the shunt group was lower than that in the occlusion group [(373±42) ng/L vs (481±19) ng/L, P=0.001]. There were no significantly differences in the amount of bleeding among the three groups (P=0.191). Conclusion: The selected method of occlusion or shunting depending on the flow condition of target coronary artery in OPCABG can decrease anastomosis time and myocardial injury.