Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery.

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.