Effect of intracoronary shunt on right ventricular function during off-pump grafting of dominant right coronary artery with poor collateral.
Although numerous studies have validated the efficacy of intracoronary shunt on reducing left ventricular dysfunction during off-pump coronary artery bypass surgery (OPCAB), there is lack of evidence supporting its role on right ventricular (RV) function during right coronary artery (RCA) revascularization. Therefore, we studied the effect of intracoronary shunt during grafting of dominant RCA without visible collateral supply on global RV function using thermodilution method. Forty patients scheduled for multivessel OPCAB with right dominant coronary circulation without collateral supply confirmed by angiography were randomized to RCA revascularization either with a shunt (n=20) or soft snare occlusion (n=20). RV ejection fraction (RVEF) was recorded at baseline, during RCA grafting, and 15 min after reperfusion. Corresponding RV stroke work index (RVSWI) was calculated. RVEF and RVSWI decreased significantly during RCA grafting and returned to baseline values after reperfusion in both groups without any significant differences between the groups. Intracoronary shunt did not exert any beneficial effect on global RV function during RCA grafting, even in the absence of visible collateral supply. Regarding the possibility of graft failure by intracoronary shunt-induced endothelial damage, routine use of intracoronary shunt during RCA grafting is not recommended in patients with preserved biventricular function.
Shim
Jae-Kwang
JK
Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, Korea.
Bang
Sou-Ouk
SO
Lee
Jong-Hwa
JH
Oh
Young-Jun
YJ
Yoo
Kyung-Jong
KJ
Kwak
Young-Lan
YL
D000368:Aged; D001794:Blood Pressure; D003097:Collateral Circulation; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D013318:Stroke Volume; D013566:Sympathomimetics / Q000008:administration & dosage; D013815:Thermodilution; D016278:Ventricular Function, Right
D013566:Sympathomimetics; D009638:Norepinephrine