Acute effects of tourniquet occlusion and intraluminal shunts in beating heart surgery

Abstract

The intimal lesions observed after tourniquet occlusion in our experimental off-pump surgery model confirmed other recent studies. In contrast, utilization of TILS caused only minor damage of the vessel wall. The endothelial abrasions detected in this group may be a consequence of micro-dislocations or insertion maneuvers. Chronic studies are necessary to verify as to whether the mild injury after TILS insertion will result in a reduction or even absence of de-novo stenoses compared with tourniquet occlusion.

Intracoronary Shunt Versus Bulldog Clamp in Off-Pump Bypass Surgery. Endothelial Trauma: Shunt Versus Clamp

“…Clinical and histopathological safety of TICS is controversial. There are some reports advocating for TICS [7,18,19]. In a porcine model, Wipperman et al recommended the use of TICS instead of external occlusion devices based on acute and chronic vascular changes [13].…”

“…New cut slides were stained histochemically with AgNO3 and immunohistochemically with CD31 (JC70A; DAKO, Denmark), which, along with HE slides, gave better information about the changes in the vascular structure. The endothelial and coronary wall damages were graded as follows: grade 0: characteristic injuries not found; grade 1: isolated existing; grade 2: usually existing; grade 3: always existing, according to Wippermann et al [7]. In addition to evaluation of vascular damage, presence of intimal hyperplasia and denudation were also noted.…”

“…External occlusion can be responsible for coronary artery damage. Recently, TICS are almost routinely used in off-pump revascularization to facilitate the anastomosis, while maintaining myocardial blood supply and a bloodless surgical field [6,7]. Vascular endothelial injury may occur after the application of a TICS and/or a bulldog clamp to a coronary artery during OPCAB.…”

Elective minimally invasive coronary artery bypass: Shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study

“…Wippermann et al have shown in an animal study that intraluminal shunts cause only moderate trauma to the vessel and may therefore be superior regarding acute and chronic intimal integrity in contrast to tournique occlusion [11,12]. In contrast, some investigators revealed that intracoronary shunts might create a greater degree of endothelial dysfunction compared to extravascular devices such as bulldog clamps or double-looped Gore-Tex suture snaring.…”

“…Clinical and histopathological safety of tournique occlusion or intraluminal shunt technique remains controversial [11-15]. The aim of this study was to evaluate the benefit of intraluminal-LAD shunt on myocardial damage in MIDCAB patients.…”