title: Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate the role of intracoronary shunt during off-pump coronary artery bypass surgery.
  
  
  METHODS
  Fifty-six patients undergoing off-pump coronary artery bypass using the left internal mammary artery to bypass the left anterior descending coronary artery were randomly assigned to have the bypass performed with intracoronary shunt or by occlusive snaring. Ischemia during grafting was monitored by tissue Doppler. Hemodynamic status and indicators of ischemia were monitored, and on-table and postoperative angiography were performed.
  
  
  RESULTS
  In patients with retrograde filling of the left anterior descending coronary artery, ischemia did not develop, but occlusion of antegradely perfused vessels caused ischemia in 26 of 33 patients. Ischemia was reversed in 14 of 16 shunted patients, and in 3 of 17 nonshunted cases (p = 0.004). Angiography showed a trend toward improved on-table angiographic results in shunted patients. After 3 months, graft patency was 100%, but 1 patient treated without shunt required reintervention and 15 patients had new angiographic lesions, equally distributed between shunted and nonshunted patients.
  
  
  CONCLUSIONS
  Intracoronary shunt prevents ischemia during grafting of the left anterior descending coronary artery and provides satisfactory immediate- and short-term graft patency.
authors.affiliation: The Interventional Centre, Rikshospitalet, University of Oslo, Oslo, Norway. nielsb@aol.com
authors.forename: Jacob
authors.initials: J
authors.lastname: Bergsland
authors.forename: Per Snorre
authors.initials: PS
authors.lastname: Lingaas
authors.forename: Helge
authors.initials: H
authors.lastname: Skulstad
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hol
authors.forename: Per Steinar
authors.initials: PS
authors.lastname: Halvorsen
authors.forename: Rune
authors.initials: R
authors.lastname: Andersen
authors.forename: Milada
authors.initials: M
authors.lastname: Småstuen
authors.forename: Runar
authors.initials: R
authors.lastname: Lundblad
authors.forename: Jan
authors.initials: J
authors.lastname: Svennevig
authors.forename: Kai
authors.initials: K
authors.lastname: Andersen
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology