Influence of intracoronary shunt on myocardial damage: a prospective randomized study

Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery. Results One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff ( p = 1). There were no significant differences in between both groups at all studied timepoints. Conclusion There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass.

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“…This was confirmed by studying OPCAB patients with multivessel disease (MVD) and moderate left ventricular dysfunction [19]. …”

Section: Discussionmentioning

confidence: 95%

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

Šorm

Vojacek

Čermáková

et al. 2012

J Cardiothorac Surg

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“…They highlighted that this elevation may be interpreted as a reversible injury rather than a frank myocardial necrosis, so they advise the usage of shunt in patients prone to transient ischemia. Emmiler et al [14] compared shunt group with shuntless on the basis of cardiac enzymes and echocardiographic evaluation. Their findings were consistent with the results of Gurbuz et al [12] and Bozok et al [13] In both studies, the coronary lesions did not exhibit retrograde filling.…”

Section: Discussionmentioning

confidence: 99%

A prospective study on indication of intracoronary shunt during off-pump coronary bypass grafting surgery for single-vessel disease

Tüfekçi¹

2016

Turk Gogus Kalp Dama

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Bu çalışmada damarda retrograd akım olan ve olmayan sol ön inen arter lezyonu olan hastalarda atan kalpte koroner arter baypas cerrahisi sırasında intrakoroner şant kullanımının faydalı olup olmadığı araştırıldı. Ça lış ma pla nı: Nisan 2007-Mart 2014 tarihleri arasında kliniğimizde atan kalpte koroner arter baypas cerrahisi ile tedavi edilen toplam 80 hasta (54 erkek, 26 kadın; ort. yaş 61.9 yıl; dağılım 36-82 yıl) çalışmaya dahil edildi. Hastaların yarısında anjiyografik olarak gösterilmiş tıkalı (%100) sol ön inen arter hastalığı varken diğer yarısında tam tıkalı olmayan (%70-99) sol ön inen arter hastalığı vardı. Bu hastalar tıkanıklık derecesi ve intrakoroner şant kullanımına göre dört gruba randomize edildi. Gruplar; anastomoz süresi, troponin I, kreatinin kinaz ve kreatinin kinaz miyokardiyal izoenzimi serum düzeyleri açısından karşılaştırıldı. Bul gu lar: İntrakoroner şant kullanılan gruplarda ameliyat sonrası kreatinin kinaz miyokardiyal izoenzimi ve troponin düzeyleri anlamlı derecede düşük idi. Buna karşın, şant kullanılan ve kullanılmayan gruplarda ameliyat öncesi kreatinin kinaz miyokardiyal izoenzimi, troponin düzeyleri ve ameliyat öncesi ve sonrası kreatinin kinaz düzeyleri açısından farklılık yoktu. So nuç: İntrakoroner şant özellikle anatomik zorlukları ve kritik hastalığı olan hastalarda önerilebilir. Atan kalpte koroner arter baypas greft cerrahisinde intrakoroner şantların endikasyonlarını ortaya koyacak ileri klinik çalışmalara ihtiyaç vardır. Anah tar söz cük ler: Koroner baypas cerrahisi; miyokardiyal yaralanma; atan kalpte koroner arter baypas greft cerrahisi; şant.

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“…An arteriotomy is made on the target. Then a intracoronary shunt is quickly inserted into the coronary artery (Figure 2 middle) and the proximal snare is released (Figure 3 bottom) (Emmiler et al, 2008). The sizing of the shunt is important.…”

Section: Anterior Wall Revascularizationmentioning

confidence: 99%

Current Trend of Off-Pump Coronary Artery Bypass Grafting

Hirose¹

2012

Front Lines of Thoracic Surgery

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Influence of intracoronary shunt on myocardial damage: a prospective randomized study

Abstract: Intracoronary shunt has protective effects on myocardium in patients with moderate left ventricular dysfunction.

Cited by 10 publications

References 22 publications

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

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

A prospective study on indication of intracoronary shunt during off-pump coronary bypass grafting surgery for single-vessel disease

Current Trend of Off-Pump Coronary Artery Bypass Grafting

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