title: Intracoronary shunt versus bulldog clamp in off-pump bypass surgery. Endothelial trauma: shunt versus clamp.
abstract: BACKGROUND
  During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model.
  
  
  METHODS
  Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted.
  
  
  RESULTS
  Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades.
  
  
  CONCLUSIONS
  The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.
authors.affiliation: Department of Cardiovascular Surgery, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey. ahvural@gmail.com
authors.forename: A Hakan
authors.initials: AH
authors.lastname: Vural
authors.forename: Serhat
authors.initials: S
authors.lastname: Yalcinkaya
authors.forename: Tamer
authors.initials: T
authors.lastname: Türk
authors.forename: Gündüz
authors.initials: G
authors.lastname: Yümün
authors.forename: Nihal
authors.initials: N
authors.lastname: Gül
authors.forename: Ulviye
authors.initials: U
authors.lastname: Yalcinkaya
authors.forename: Metin
authors.initials: M
authors.lastname: Kaya
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ozyazicioğlu
mesh_terms: D000818:Animals; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003331:Coronary Vessels / Q000293:injuries / Q000601:surgery* / Q000648:ultrastructure; D004285:Dogs; D004730:Endothelium, Vascular / Q000293:injuries / Q000601:surgery* / Q000648:ultrastructure; D013525:Surgical Instruments / Q000009:adverse effects