Perfusion flow assessment of coronary shunt during off-pump coronary artery bypass grafting.
BACKGROUND
Coronary shunts are widely used to prevent myocardial ischemia during off-pump coronary artery bypass graft (OPCAB) procedures. Although clinical effectiveness has been reported, actual perfusion flow has not been well assessed. The purpose of this study was to evaluate actual shunt flow and its pattern during passive coronary perfusion in clinical OPCAB.


METHODS
In 15 OPCAB cases, the coronary perfusion flow of the external shunt (1.7 or 2.0 mm) during anastomosis and the free flow of the shunt were measured with an in-line electromagnetic or ultrasonic flow probe. The perfused coronary blood vessel was either the left anterior descending coronary artery or the right coronary artery. The inflow vessel of the external shunt was either the femoral artery (FA) or the ascending aorta (AA).


RESULTS
Free flow values of a 1.7-mm FA shunt, 1.7-mm AA shunt, and 2.0-mm FA shunt were 34+/- 7, 39 +/- 3, and 44 +/- 7 mL/min. Perfusion flows were 13 +/- 4, 14 +/- 3, and 22 +/- 4 mL/min, respectively. Perfusion flow was significantly lower than free flow and correlated well with coronary resistance. Although inflow site did not influence net perfusion flow, diastolic/systolic flow fraction ratio was significantly greater when the shunt was perfused from the FA.


CONCLUSIONS
External shunt from FA would provide limited but effective perfusion flow with a physiological pattern, which is passively regulated by coronary resistance.
Arai
Hirokuni
H
Department of Cardiothoracic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Japan. hiro.tsrg@tmd.ac.jp
Kozakai
Akira
A
Manabe
Susumu
S
Kawaguchi
Satoru
S
Shimizu
Masato
M
Egi
Koso
K
Tabuchi
Noriyuki
N
Tanaka
Hiroyuki
H
Sunamori
Makoto
M
D000368:Aged; D001783:Blood Flow Velocity; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome