Elective minimally invasive coronary artery bypass: shunt or tournique occlusion? Assessment of a protective role of perioperative left anterior descending shunting on myocardial damage. A prospective randomized study.
BACKGROUND
To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass.


METHODS
38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n= 19). Blood samples for cardiac troponin T were collected at 30 minutes prior to, 6 and 24 hours after surgery.


RESULTS
One patient in external tournique occlusion and two patients in intraluminal-left anterior descending shunt group were excluded from futher analysis due to preoperative cardiac troponin T level above the 99th-percentile. Postoperatively, each six patients in external tournique occlusion (33.3%) and intraluminal-left anterior descending shunt (35.3%) group were above the 99th-percentile. Two patients from each group (external tournique occlusion group 11.1% vs. intraluminal-left anterior descending shunt group 11.8%) had peak values above 10-% coeficient of variation cutoff (p = 1). There were no significant differences in between both groups at all studied timepoints.


CONCLUSIONS
There was no protective effect of intraluminal shunting on myocardial damage compared to short-term tournique occlusion. It is upon the surgeon's discretion which method may preferrably be used to achieve a bloodless field in grafting of the non-occluded left anterior descending in minimally invasive coronary artery bypass.
Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 50005, Hradec Kralove, Czech Republic.
Zdenek
Z
Sorm
Jan
J
Vojacek
Eva
E
Cermakova
Radek
R
Pudil
Ulrich A
UA
Stock
Jan
J
Harrer
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006335:Heart Injuries / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019990:Perioperative Care; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D060205:Therapeutic Occlusion / Q000379:methods*; D014111:Tourniquets