title: Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  Intracoronary shunts have been developed for a bloodless field and preserved forward flow preventing ischemia during off-pump coronary artery bypass (OPCAB) surgery. However, reports directly measuring the forward flow through the shunt in clinical settings are lacking.
  
  
  METHODS
  Using a 7.5-MHz Doppler probe, we investigated the coronary flow through a 1.5-mm shunt inserted into the left anterior descending artery (LAD) for anastomosis with the internal thoracic artery during OPCAB in 30 consecutive patients. The following Doppler flow parameters were obtained before and after shunting: peak velocity, mean velocity, time-velocity integral, and flow.
  
  
  RESULTS
  No patients developed significant electrocardiographic changes and the peak value of postoperative myocardial band of creatine kinase was 17 ± 16 IU/L. All Doppler flow parameters of the LAD decreased significantly after shunting; peal velocity: 71.3 ± 34.6 cm/second to 54.5 ± 25.3 cm/second (-24% ± 27%), mean velocity: 33.3 ± 18.3 cm/second to 26.3 ± 14.0 cm/second (-21% ± 23%), and time-velocity integral: 28.7 ± 12.1 cm to 19.0 ± 7.1 cm (-28% ± 14%), and flow: 38.7 ± 16.8 mL/minute to 25.0 ± 9.5 mL/minute (-31% ± 13%) (P < .01).
  
  
  CONCLUSIONS
  The LAD flow is preserved at least 50% through a 1.5-mm intracoronary shunt, although the flow pattern was attenuated, during OPCAB anastomosis. The Doppler evaluation of the coronary artery flow before and after shunting is useful to justify the protective use of the shunt on myocardial perfusion during OPCAB.
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. Electronic address: takami@nagoya2.jrc.or.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takami
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tajima
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hibino
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Munakata
authors.affiliation: Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D052279:Creatine Kinase, MB Form / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012212:Rheology
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: 23.1.2; 36.2; 38.2; CK; CK-MB; ITA; LAD; OPCAB; RCA; TVI; creatine kinase; creatine kinase myocardial band; internal thoracic artery; left anterior descending; off-pump coronary artery bypass; right coronary artery; time-velocity integral