Techniques and results of off-pump coronary artery bypass grafting using homemade intracoronary shunt.
BACKGROUND
The outcome of the off-pump coronary artery bypass grafting (CABG) is highly dependent on surgical techniques. To overcome problems of intraoperative hemodynamic instability and avoid potential injury to coronary artery arising from occlusive technique, the authors have modified the strategy of performing distal anastomosis by using the authors' homemade intracoronary artery shunt.


OBJECTIVE
To document the results of off-pump CABG using the authors' homemade intracoronary shunt. The characteristics of shunt and techniques are demonstrated.


METHODS
The shunt is constructed from silicone tubing (Allied Biomedical Company, Paso Robles, CA). It has been successfully used for distal anastomoses in off-pump coronary artery bypass surgery. All 170 consecutive patients who had off-pump CABG from October 2002 to May 2005 were evaluated. Data were collected retrospectively. Average grafts per patient were 3.5. Arterial grafts were used in most cases (90%). Conversion rate was 2.8%. Patients were followed up at 3 weeks, 6 weeks, and bimonthly thereafter.


RESULTS
In a 23-month follow-up, the operative mortality rate was 0.5% (one patient). Complications included stroke in 3 patients (1.8%) and post-operative AF in 12 patients (7.12%). Of 170 patients, 12 patients (7.05%) required intraoperative or postoperative intraaortic balloon pump support. The early results were good and satisfactory.


CONCLUSIONS
Off-pump CABG can be successfully performed using the authors' homemade intracoronary artery shunt with better hemodynamic control. The techniques are safe, simple, reliable, and effective.
Chaiyaroj
Suchart
S
Cardiothoracic Surgery Unit, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Rd, Bangkok 10400, Thailand. tescx@mahidol.ac.th
Viengteeravat
Somchai
S
Bhumarangura
Wipapon
W
Khajarern
Siam
S
Leelayana
Parinya
P
Purintrapiban
Boontiva
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D013785:Thailand