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J Thorac Cardiovasc Surg 2003;125:1160-1162
© 2003 The American Association for Thoracic Surgery

Brief Communications

Intracoronary artery shunt: An assessment of possible coronary artery wall damage

From the Departments of Cardiovascular Surgery^a and Cardiovascular Pathology,^b University of Padua Medical School, Padua, Italy.

Received for publication April 26, 2002. Accepted for publication Aug 6, 2002. Address for reprints: Gino Gerosa, MD, Istituto di Chirurgia Cardiovascolare, Via Giustiniani, 1, 35121 Padova, Italy (E-mail: gino.gerosa@unipd.it).

The first 20% of the full text of this article appears below.

Multivessel off-pump coronary artery bypass (OPCAB) is currently feasible in many patients ^1,2 and yields anastomoses of excellent quality. Intracoronary shunts are routinely used to ensure an optimal bloodless operative field and to reduce the onset of myocardial ischemia. ³ However, the effects of these devices on coronary artery endothelial integrity have not been throughly assessed.

The aim of this study was to investigate such effects on coronary endothelial cells and the artery wall in a human model that would exactly mimic the atheromatous coronary artery scenario of patients with ischemic coronary artery disease.

Patients and methods

Informed consent was obtained. Eight patients who underwent heart transplantation for dilated cardiomyopathy caused by ischemic coronary artery disease were included in the study group. Intravenous heparin (3 mg/kg) was administered to maintain an activated clotting time of greater than 400 seconds. Before the start of cardiopulmonary bypass (CPB) on the beating heart, an intracoronary shunt (DLP, Medtronic, Inc, Minneapolis, Minn) was inserted, with the left anterior descending coronary artery (LAD) as the target vessel (Figure 1).

View larger version (111K): [in this window] [in a new window]   Fig. 1. Intraoperative view of the left descending coronary artery with the inserted intraluminal shunt, Prolene 5-0 suture (proximal and distal), and a single arm of the Octopus stabilizer. Note that the patient is cannulated, with the rapid possibility to switch in CPB any time it was requested.

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