HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Johannes M. Albes Karl R. Karsch Gerhard Ziemer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Menon, A. K. Articles by Ziemer, G. Search for Related Content PubMed PubMed Citation Articles by Menon, A. K. Articles by Ziemer, G. Related Collections Minimally invasive surgery

Ann Thorac Surg 2002;73:1418-1423
© 2002 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Occlusion versus shunting during MIDCAB: effects on left ventricular function and quality of anastomosis

^a Department of Thoracic, Cardiac and Vascular Surgery, Eberhard-Karls-University, Tübingen, Germany
^b Department of Cardiology, Eberhard-Karls-University, Tübingen, Germany

Accepted for publication January 23, 2002.

* Address reprint requests to Dr Menon, Department of Thoracic, Cardiac, and Vascular Surgery, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany
e-mail: asmenon{at}med.uni-tuebingen.de

Background. Minimally invasive direct coronary artery bypass is an established clinical procedure for revascularization of the left anterior descending coronary artery. Mechanical stabilization and temporary occlusion is currently used to perform the anastomosis of the internal thoracic artery to the left anterior descending coronary artery. However, critical reduction of cardiac function can occur as a result of temporary ischemia. The purpose of this study was to evaluate whether ischemic sequelae can be avoided by using temporary intraluminal shunts and whether this alters early outcome.

Methods. Thirty-five patients underwent minimally invasive direct coronary artery bypass revascularization using a mechanical stabilizer. In group A (n = 20), the anastomotic site was temporarily occluded by tourniquets. In group B (n = 15), temporary intraluminal shunts were inserted into the anastomotic site without any occlusion of the left anterior descending coronary artery. Anastomosis of the internal thoracic artery to the left anterior descending coronary artery was performed in an identical fashion. A Swan-Ganz catheter was inserted, and transesophageal echocardiographic measurements were obtained for analysis of left ventricular (LV) function. Regional wall motion, cardiac index, stroke volume index, systolic and diastolic LV diameters, and fractional area change were measured during four periods: at the start of the operation (baseline), placement of the stabilizer (stabilization), left anterior descending coronary artery occlusion (occlusion) or insertion of temporary intraluminal shunts (shunt), and 30 minutes after reperfusion (reperfusion). Angiograms were obtained 4 to 6 days postoperatively.

Results. In group A, LV performance, cardiac index, stroke volume index, and fractional area change decreased during occlusion whereas systolic diameters increased. Almost two myocardial segments per patient developed severe hypokinesia in the perfusion area. These changes disappeared after 30 minutes of reperfusion, with increased LV function. In group B, LV function remained stable whereas hypokinetic wall motion was only detected in 2 patients. Early angiograms revealed 90% of the grafts were patent in group A versus 100% in group B. The need for percutaneous intervention during the first 6 months was 20% in group A versus 6.7% in group B.

Conclusions. The use of temporary intraluminal shunts resulted in reduced acute ischemia and revealed wall motion abnormalities and maintained LV function. Furthermore, this technique suggests an improvement of early graft patency and a lower reintervention rate within the first 6 postoperative months. Thus, use of temporary intraluminal shunts appears to be superior to the occlusion technique early after minimally invasive direct coronary artery bypass procedures.

This article has been cited by other articles:

				R. M. Mentzer Jr, M. S. Jahania, and R. D. Lasley Myocardial Protection Card. Surg. Adult, January 1, 2008; 3(2008): 443 - 464. [Full Text]

				S. P. Collison, A. Agarwal, and N. Trehan Controversies in the use of intraluminal shunts during off-pump coronary artery bypass grafting surgery. Ann. Thorac. Surg., October 1, 2006; 82(4): 1559 - 1566. [Abstract] [Full Text] [PDF]

				J. Wippermann, J. M. Albes, R. Bruhin, M. Hartrumpf, R. Vollandt, H. Kosmehl, and T. Wahlers Chronic ultrastructural effects of temporary intraluminal shunts in a porcine off-pump model Ann. Thorac. Surg., August 1, 2004; 78(2): 543 - 548. [Abstract] [Full Text] [PDF]

				M. Zimarino, S. Gallina, M. Di Fulvio, M. Di Mauro, G. Di Giammarco, R. De Caterina, and A. M. Calafiore Intraoperative ischemia and long-term events after minimally invasive coronary surgery Ann. Thorac. Surg., July 1, 2004; 78(1): 135 - 141. [Abstract] [Full Text] [PDF]

				H. B. Hangler, K. Pfaller, E. Ruttmann, D. Hoefer, T. Schachner, G. Laufer, and H. Antretter Effects of intracoronary shunts on coronary endothelial coating in the human beating heart Ann. Thorac. Surg., March 1, 2004; 77(3): 776 - 780. [Abstract] [Full Text] [PDF]

				J. Wippermann, J. M. Albes, H. Brandes, H. Kosmehl, R. Bruhin, and T. Wahlers Acute effects of tourniquet occlusion and intraluminal shunts in beating heart surgery Eur. J. Cardiothorac. Surg., November 1, 2003; 24(5): 757 - 761. [Abstract] [Full Text] [PDF]

				R. M. Mentzer Jr., M. S. Jahania, and R. D. Lasley Myocardial Protection Card. Surg. Adult, January 1, 2003; 2(2003): 413 - 438. [Full Text]