Document Detail


Selective left anterior descending shunting provides effective off-pump myocardial protection.
MedLine Citation:
PMID:  20103200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary artery shunting during off-pump coronary artery bypass OPCAB procedures has been addressed only infrequently. To assess the protective effect of shunting, we examined CABG patients' postoperative cardiac enzyme levels and preoperative and postoperative ejection fractions. METHODS: During OPCAB, we selectively shunted the left anterior descending coronary artery (LAD) to provide myocardial protection when ischemia developed. We prospectively gathered data from 408 consecutive patients who underwent OPCAB. Data on shunt status were available for 386 of these patients. A "flow-through" shunt providing perfusion to the distal LAD was used whenever ST-segment elevations greater than 2 mm occurred or when patients had hemodynamic compromise unexplained by cardiac manipulation. Ejection fraction was assessed 1 to 3 days preoperatively and again 3 to 10 days postoperatively. Creatine kinase (muscle/brain) levels were assessed postoperatively for 24 hours. RESULTS: During OPCAB, 99 patients required shunting for presumed ischemia. Thirty-day cardiac mortality was 1.4% (4 of 296 without a shunt; 0 of 90 with a shunt). In patients without a LAD shunt, the mean peak creatine kinase index was 5.3; in patients who needed a shunt, the index was 5.2. Mean ejection fraction improved from 0.536 to 0.589 in the shunted patients and from 0.53.5 to 0.586 in the nonshunted patients. CONCLUSIONS: Selective shunting of the LAD during OPCAB provides effective protection against myocardial ischemia when ischemia is detected by electrocardiogram or when hypotension develops that is unexplained by cardiac manipulation.
Authors:
George V Letsou; Gary L Grunkemeier; Abhijit L Salaskar; Charudatta Bavare; YingXing Wu; Murtuza M Rampurwala
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-03-04     Revised Date:  2010-09-30    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  24-9     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
The University of Texas Medical School and Health Science Center, Houston, Texas, USA. george.v.letsou@uth.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass, Off-Pump / methods*
Electrocardiography
Female
Follow-Up Studies
Humans
Internal Mammary-Coronary Artery Anastomosis / methods*
Male
Myocardial Ischemia / mortality,  physiopathology,  surgery*
Prospective Studies
Stroke Volume
Survival Rate
Treatment Outcome
United States / epidemiology
Comments/Corrections
Comment In:
Ann Thorac Surg. 2010 Oct;90(4):1394; author reply 1394-5   [PMID:  20868866 ]
Ann Thorac Surg. 2010 Aug;90(2):700-1; author reply 701   [PMID:  20667399 ]

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