Protective role of intracoronary shunt in off-pump coronary bypass operations

Abstract

Objective: To investigate if there are any advantages in using intracoronary shunts compared to shuntless operations, in the context of whether it has a protective role for the myocardia.Methods: This prospective study, included 100 patients who underwent off-pump coronary bypass surgery at 2 different cardiovascular surgery departments, namely, the Social Security Ankara Ihtisas Hospital, and Hacettepe University Hospital, Turkey, between September 2002 and July 2006. Patients were divided into 2 groups. In group 1 (n=50) off-pump coronary bypass operations were performed with intracoronary shunts. In group 2 (n=50) shunts were not used during off-pump. Serum creatine kinase, myoglobin, and troponin were studied.Results: There were significant increases in serum creatine kinase levels in group 2 at postoperative 6th, 12th, and 24th hours. In group 2, the increase of myoglobin was statistically significant at only the postoperative 24th hour. Troponin levels were significantly higher in group 2 at postoperative 6th, 12th, and 24th hours.Conclusion: There are some questions regarding myocardial protection while maintaining a bloodless secure surgical field in off-pump coronary surgery. However, use of intracoronary shunts provides distal coronary flow, and reduces the risk of myocardial ischemia, while maintaining a comfortable blood free anastomosis area.