Snaring of the target vessel in less invasive bypass operations does not cause endothelial dysfunction.
BACKGROUND
Minimally invasive coronary artery bypass grafting aims to achieve less patient discomfort and a more rapid return to active life. Most approaches have used maintenance of the beating heart and control of the target coronary vessel by different hemostatic devices. The purpose of this study was to assess the effects of commonly used coronary artery snares and of the occlusion of the coronary vessel necessary for minimally invasive coronary artery operations on coronary endothelial function.


METHODS
Coronary artery bypass grafting with an internal mammary artery to left anterior descending artery anastomosis was performed in a porcine model with a 30-minute period of ischemia and a subsequent 30-minute period of reperfusion, using snares on either side of the anastomotic site to achieve hemostasis of the operative field. Endothelium-dependent relaxation to serotonin was studied in conventional organ chamber experiments with rings taken from the left anterior descending artery at the proximal snare site, the anastomotic site in the segment that underwent the ischemia-reperfusion cycle, the distal snare site, and at a control segment. Responses to potassium chloride and bradykinin were also compared.


RESULTS
There were no significant differences in endothelium-dependent relaxation values among the four sites studied.


CONCLUSIONS
These results confirm that snaring of the coronary artery for achieving hemostasis at the anastomotic site when performing coronary artery bypass grafting on the beating heart does not cause endothelial dysfunction.
Perrault
L P
LP
Cardiovascular Division, Institut de Recherches Servier, Suresnes, France.
Menasché
P
P
Bidouard
J P
JP
Jacquemin
C
C
Villeneuve
N
N
Vilaine
J P
JP
Vanhoutte
P M
PM
D000818:Animals; D003331:Coronary Vessels / Q000502:physiology / Q000601:surgery*; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods*; D007430:Intraoperative Care; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology; D013552:Swine