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 offpump 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 chisquare 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%.


CONCLUSIONS
We conclude that routine intracoronary shunting in OPCABG is a safe technique that is associated with good myocardial preservation and allows for total revascularization with a low rate of conversion to CPB.
Balkhy
Husam H
HH
Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Milwaukee, Wisconsin, USA. skidoc@execpc.com
Quinn
Curtis C
CC
Lois
Kathryn H
KH
Munsch
Carol M
CM
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D012189:Retrospective Studies; D018570:Risk Assessment