Off-pump coronary bypass grafting with or without the use of intracoronary shunts

Ehab  Salah Eldin Elsharkawe; Hend  Mahmoud Nasser; Hosam Fathy Ali

doi:10.35810/ects.v2i4.147

Ehab Salah Eldin Elsharkawe Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Hend Mahmoud Nasser Department of Anesthesiology, Intensive care, Menofia University, Menofia, Egypt
Hosam Fathy Ali Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI: https://doi.org/10.35810/ects.v2i4.147

Keywords: coronary artery bypass grafting, off-pump surgery, intracoronary shunt, coronary clamping

Abstract

Background: There is scarce literature comparing the role of the intracoronary shunt during off-pump coronary artery bypass grafting (CABG). This study aimed to compare off-pump CABG using intracoronary shunt versus the coronary clamp during distal coronary artery anastomosis.

Methods: We conducted this randomized study between January and June 2018. We randomized 30 patients into two groups. Group A (n= 15) included patients who had coronary clamping during off-pump CABG, and Group B (n= 15) included patients who had intracoronary shunt during off-pump CABG. Study endpoints were anastomosis time and postoperative cardiac enzyme levels.

Results: The mean age of the shunt group was higher than the mean age of the clamp group (61.06 ± 7.26 vs. 56.72 ± 12.44, respectively, p=0.03). Our study showed no statistical difference between the two groups regarding sex (p˃0.99), hypertension (p˃0.99), and diabetes (p=0.14). The distal anastomosis time was longer in the shunt group than in the clamp group (39.80±4.55 vs. 32.27±6.06 minutes, respectively, p=0.001). The postoperative troponin I (0.61±0.11 vs. 0.26±0.089 ƞg/ml, p<0.001), and CK-MB levels (44.27±5.34 vs. 35.5±4.86 IU/L, p<0.001) were significantly higher in the clamp group.

Conclusion: The intracoronary shunt could be associated with lower cardiac enzyme release compared to the clamp technique. However, it was associated with a longer distal anastomosis time.