Routine Intracoronary Shunting in Multivessel Off-Pump Coronary Artery Bypass: A Retrospective Review of in-Hospital Outcomes in 550 Consecutive Cases
Background: Since 1999 our institution has adopted off-pump coronary artery bypass grafting (OPCABG) for treating the majority of our patients. In the year 2001, 96% of our isolated coronary bypass procedures were performed on the beating heart. Routine use of intracoronary shunts in OPCABG has been a controversial topic. We use routine intracoronary shunting in all cases to maintain distal perfusion and to help achieve hemostasis.
Methods: We reviewed the first 550 OPCABG procedures performed at our institution (July 1998-December 2001) by 2 surgeons currently performing >95% of all coronary bypasses off-pump. All cases were completed with routine intracoronary shunting using Flo-Coil (Guidant, Santa Clara, CA, USA) or Flo-Thru (Bio-Vascular, St Paul, MN, USA) shunts. The mean number of grafts was 3.7. (range, 1-8). In-hospital outcomes in this series of patients were compared to outcomes in 485 patients operated on by the same 2 surgeons using traditional cardiopulmonary bypass (CPB) and aortic cross-clamping prior to adopting routine OPCABG. Statistical significance was calculated using Pearson chi-square analysis and reported for P values of <.05.
Results: The rates of occurrence of postoperative cardiovascular accident, atrial fibrillation, prolonged ventilator time, renal failure, and blood product use and the length of postoperative stay were significantly less in the off-pump group (P < .05). Predicted risk of mortality, observed mortality, and perioperative myocardial infarction rates were not significantly different in the 2 groups (P < .05). The conversion rate was 3.1%.
Conclusion: We conclude that routine intracoronary shunting in OPCABG is a safe technique that is associated
Yeatman M, Caputo M, Narayan P, et al. 2002. Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. Ann Thorac Surg 73:1411-7.nGerritsen WB, van Boven WJ, Driessen AH, Haas FJ, Aarts LP. 2001. Off-pump versus on-pump coronary artery bypass grafting oxidative stress and renal function. Eur J Cardiothorac Surg 20923-9.nHart JC, Spooner T, Edgerton J, et al. 1999. Off-pump multivessel coronary artery bypass utilizing the Octopus tissue stabilization system: initial experience in 374 patients from three separate centers. Heart Surg Forum 2:15-28.nHernandez F, Cohn WE, Baribeau YR, et al. 2001. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multi-center experience. Ann Thorac Surg 72:1528-33; Discussion 1533-4.nKirk KC, Aldridge RA, Sistino JJ, et al. 2001. Coronary artery bypass grafting with and without cardiopulmonary bypass: a comparison analysis. J Extra Corpor Technol 33:86-90.nLancey RA, Soller BR, Van der Salm TJ. Off pump vs. on pump coronary artery bypass surgery: a case matched comparison of clinical outcomes and costs. Presented at: 3rd Annual meeting of the ISMICS; June 2000; Atlanta, Ga, USA.nLoef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH. 2002. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest 121:1190-4.nMagee MJ, Jablonski KA, Stamou SC, et al. 2002. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 73:1196-203.nAngelini GD, Taylor FC, Reeves BC, Ascione R. 2002. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-9.nAscione R, Caputo M, Calori G, et al. 2000. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation 102:1530-5.nAscione R, Williams S, Lloyd CT, et al. 2001. Reduced postoperative blood loss and transfusion requirement after beating heart coronary operations: A prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.nBaumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Katouzian A, Yokoyama T. Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach. Ann Thorac Surg 67:1653-8.nBoyd WD, Desai ND, Del Rizzo DF, Novick RJ, McKenzie FN, Menkis AH. 1999. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg 68:1490-3.nBull DA, Neumayer LA, Stringham JC, Meldrum P, Affleck DG, Karwande SV. 2001. Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost? Ann Thorac Surg 71:170-3; Discussion 173-5.nDapunt OE, Raji MR, Jeschkeit S, et al. 1999. Intracoronary shunt insertion prevents myocardial stunning in a juvenile porcine MIDCAB model absent of coronary artery disease. Eur J Cardiothorac Surg 15:173-8; Discussion 178-9.nDemaria RG, Fortier S, Carrier M, Perrault LP. 2001. Early multifocal stenosis after coronary artery snaring during off-pump coronary artery bypass in a patient with diabetes. J Thorac Cardiovasc Surg 122:1044-5.nMcKay RG, Mennett RA, Gallagher RC, et al. 2001. A comparison of ON-PUMP vs OFF-PUMP coronary artery bypass surgery among low, intermediate, and high-risk patients: the Hartford Hospital experience. Conn Med 65:515-21.nOkazaki Y, Takarabe K, Murayama J, et al. 2001. Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation. Eur J Cardiothorac Surg 19:834-9.nRicci M, Karamanoukian HL, Abraham R, et al. 2000. Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass. Ann Thorac Surg 69:1471-5.nRivetti LA, Gandra SM. 1998. An intraluminal shunt for off-pump coronary artery bypass grafting. Report of 501 consecutive cases and review of the technique. Heart Surg Forum 1:30-6.nStamou SC, Corso PJ. 2001. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg 71:1056-61.nTrehan N, Mishra M, Sharma OP, Mishra A, Kasliwal RR. 2001. Further reduction in stroke after off-pump coronary artery bypass grafting: a 10-year experience. Ann Thorac Surg 72:S1026-32.nYeatman M, Caputo M, Ascione R, Ciulli F, Angelini GD. 2001. Off- pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome. Eur J Cardiothorac Surg 19:239-44.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).