Document Detail

Effects of intracoronary shunts on coronary endothelial coating in the human beating heart.
MedLine Citation:
PMID:  14992870     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Local occlusion of coronary arteries during beating heart revascularization leads to injury of the arterial wall especially disturbing the integrity of the endothelium. The aim of this study was to elucidate the effects of intracoronary shunts versus local occlusion with elastic silicone loops on the beating heart in human coronary arteries by scanning electron microscopy. METHODS: Coronary arteries of patients with dilated cardiomyopathy (n = 4) or ischemic heart disease (n = 8) undergoing heart transplantation were locally occluded either with a silicone loop or with a shunt inserted after arteriotomy. Unmanipulated segments of the coronary arteries served as controls. Integrity of the endothelial lining was observed with scanning electron microscopy. RESULTS: Scanning electron microscopy revealed a statistically significant higher injury after shunting compared with controls (p < 0.001) and vessel loop occlusion (p < 0.001). There was no difference between both patient groups according to control specimens or after manipulation. CONCLUSIONS: From this investigation we conclude that insertion of intracoronary shunts during beating heart surgery leads to severe endothelial denudation in human coronary arteries. Therefore, at present we recommend using intracoronary shunts selectively in cases in which critical ischemia or technical difficulties as a result of anatomic conditions are expected during anastomosis and avoiding routine shunt insertion into coronary arteries during beating heart revascularization.
Herbert B Hangler; Kristian Pfaller; Elfriede Ruttmann; Daniel Hoefer; Thomas Schachner; Guenther Laufer; Herwig Antretter
Publication Detail:
Type:  In Vitro; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  77     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-02     Completed Date:  2004-04-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  776-80     Citation Subset:  AIM; IM    
Department of Cardiac Surgery, Institute of Anatomy Histology and Embryology, Leopold-Franzens-University, Innsbruck, Austria.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Coronary Vessels / physiology,  surgery*,  ultrastructure*
Endothelium, Vascular / ultrastructure*
Microscopy, Electron, Scanning
Reg. No./Substance:
Comment In:
Ann Thorac Surg. 2005 May;79(5):1826   [PMID:  15855002 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Mortality on the waiting list for coronary artery bypass grafting: incidence and risk factors.
Next Document:  Outcomes of early extubation after bypass surgery in the elderly.