| Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. | |
| | |
MedLine Citation:
|
PMID: 12022525 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: This study investigated the hemodynamic changes in patients undergoing multiple vessel beating heart coronary revascularization in the presence or absence of an intracoronary shunt. METHODS: Forty patients were randomized to off-pump with a shunt (n = 20) or with the proximal coronary artery occluded by a soft snare (n = 20). Hemodynamic measurements were recorded at base line, during construction, and after completion of each distal anastomosis. RESULTS: Grafting of the left anterior descending coronary artery anastomosis was associated with a significant decrease in stroke volume, cardiac index, and mean arterial pressure, and an increase in pulmonary capillary wedge pressure and systemic vascular resistance in the snare but not in the shunt group. During grafting of the posterior descending coronary artery there was a marked decrease in stroke volume and cardiac index, and an increase in central venous pressure in both groups, and an increase in heart rate, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and systemic vascular resistance only in the snare group. The most extensive changes were observed during the circumflex coronary artery anastomosis with a reduction in stroke volume, cardiac index, and mean arterial pressure, and an increase in central venous pressure, pulmonary capillary wedge pressure, pulmonary arterial pressure, and systemic vascular resistance in both groups. In all settings, these changes were transient and recovered after the heart was returned to its anatomical position in the shunt group, whereas stroke volume and cardiac index remained reduced, and systemic vascular resistance was elevated in all settings in the snare group. CONCLUSIONS: Stabilization of the left anterior descending coronary artery to perform the anastomosis resulted in temporary hemodynamic changes, which are prevented by the use of an intracoronary shunt. The hemodynamic deterioration during the construction of the posterior descending coronary artery and circumflex coronary artery anastomoses is transient in the shunt group, whereas the snaring technique is associated with an impairment of early functional recovery. |
| | |
Authors:
|
Mark Yeatman; Massimo Caputo; Pradeep Narayan; Arup Kumar Ghosh; Raimondo Ascione; Ian Ryder; Gianni D Angelini |
Related Documents
:
|
9168785 - Monocyte chemotactic protein-1 increases collateral and peripheral conductance after fe... 3766755 - Microvascular distribution of coronary vascular resistance in beating left ventricle. 3981985 - Intramyocardial pressure and coronary extravascular resistance. 11454565 - Cross-sectional area and volume compliance of porcine left coronary arteries. 2252735 - Additional salutary hemodynamic effects of the combined use of the paraaortic counterpu... 7932515 - Effects of an oral prostaglandin e1 agonist on blood pressure and its determinants in e... |
Publication Detail:
|
Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: The Annals of thoracic surgery Volume: 73 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2002 May |
Date Detail:
|
Created Date: 2002-05-22 Completed Date: 2002-06-10 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 1411-7 Citation Subset: AIM; IM |
Affiliation:
|
Bristol Heart Institute, University of Bristol, United Kingdom. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Anastomosis, Surgical / methods* Coronary Artery Bypass / methods* Coronary Artery Disease / physiopathology, surgery* Female Hemodynamics / physiology Humans Intraoperative Complications / physiopathology, prevention & control* Male Middle Aged Myocardial Infarction / physiopathology, surgery* Myocardial Ischemia / physiopathology, prevention & control* Postoperative Complications / physiopathology Prospective Studies Stroke Volume / physiology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease.
Next Document: Occlusion versus shunting during MIDCAB: effects on left ventricular function and quality of anastom...