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

. 2012 Jul 18 ; 7 () : 69. [epub] 20120718

Jazyk angličtina Země Anglie, Velká Británie Médium electronic

Typ dokumentu časopisecké články, randomizované kontrolované studie, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid22809563

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. CONCLUSION: 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.

Zobrazit více v PubMed

Lichtenberg A, Klima U, Paeschke H, Pichlmaier M, Ringes-Lichtenberg S, Walles T, Goerler H, Haverich A. Impact of multivessel coronary artery disease on outcome after isolated minimally invasive bypass grafting of the left anterior descending artery. Ann Thorac Surg. 2004;78:487–491. doi: 10.1016/j.athoracsur.2003.11.044. PubMed DOI

Jaffery Z, Kowalski M, Weaver WD, Khanal S. A meta-analysis of randomized control trials comparing minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for stenosis of the proximal left anterior descending artery. Eur J Cardiothorac Surg. 2007;31:691–697. doi: 10.1016/j.ejcts.2007.01.018. PubMed DOI

Menon AK, Albes JM, Oberhoff M, Karsch KR, Ziemer G. Occlusion versus shunting during MIDCAB: effects on left ventricular function and quality of anastomosis. Ann Thorac Surg. 2002;73:1418–1423. doi: 10.1016/S0003-4975(02)03472-0. PubMed DOI

Bergsland J, Lingaas PS, Skulstad H, Hol PK, Halvorsen PS, Andersen R, Småstuen M, Lundblad R, Svennevig J, Andersen K, Fosse E. Intracoronary shunt prevents ischemia in off-pump coronary artery bypass surgery. Ann Thorac Surg. 2009;87(1):54–60. doi: 10.1016/j.athoracsur.2008.08.032. PubMed DOI

Zimarino M, Gallina S, Di Fulvio M, Di Mauro M, Di Giammarco G, De Caterina R, Calafiore AM. Intraoperative ischemia and long-term events after minimally invasive coronary surgery. Ann Thorac Surg. 2004;78(1):135–141. doi: 10.1016/j.athoracsur.2003.12.030. PubMed DOI

Dapunt OE, Raji MR, Jeschkeit S, Dhein S, Kuhn-Régnier F, Südkamp M, Fischer JH, Mehlhorn U. Intracoronary shunt insertion prevents myocardial stunning in a juvenile porcine MIDCAB model absent of coronary artery disease. Eur J Cardiothorac Surg. 1999;15(2):173–178. doi: 10.1016/S1010-7940(98)00290-5. PubMed DOI

Gürbüz A, Emrecan B, Yilik L, Ozsöyler I, Kestelli M, Ozbek C, Karahan N. Intracoronary shunt reduces postoperative troponin leaks: a prospective randomized study. Eur J Cardiothorac Surg. 2006;29(2):186–189. doi: 10.1016/j.ejcts.2005.11.014. PubMed DOI

Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction: universal definition of myocardial infarction. Circulation. 2007;116:2634–2653. doi: 10.1161/CIRCULATIONAHA.107.187397. PubMed DOI

Lucchetti V, Capasso F, Caputo M, Grimaldi G, Capece M, Brando G, Caprio S, Angelini GD. Intracoronary shunt prevents left ventricular function impairment during beating heart coronary revascularization. Eur J Cardiothorac Surg. 1999;15:255–259. doi: 10.1016/S1010-7940(99)00005-6. PubMed DOI

Caputo M, Chamberlain MH, Ozalp F, Underwood MJ, Ciulli F, Angelini GD. Off-pump coronary operations can be safely taught to cardiothoracic trainees. Ann Thorac Surg. 2001;71(4):1215–1219. doi: 10.1016/S0003-4975(00)02686-2. PubMed DOI

Wippermann J, Albes JM, Brandes H, Kosmehl H, Bruhin R, Wahlers T. Acute effects of tourniquet occlusion and intraluminal shunts in beating heart surgery. Eur J Cardiothorac Surg. 2003;24:757–761. doi: 10.1016/S1010-7940(03)00520-7. PubMed DOI

Wippermann J, Albes JM, Bruhin R, Hartrumpf M, Vollandt R, Kosmehl H, Wahlers T. Chronic ultrastructural effects of temporary intraluminal shunts in a porcine off-pump model. Ann Thorac Surg. 2004;78(2):543–548. doi: 10.1016/j.athoracsur.2004.02.099. PubMed DOI

Perrault LP, Menasché P, Bidouard JP, Jacquemin C, Villeneuve N, Vilaine JP, Vanhoutte PM. Snaring of the target vessel in less invasive bypass operations does not cause endothelial disfunction. Ann Thorac Surg. 1997;63:751–755. doi: 10.1016/S0003-4975(96)01118-6. PubMed DOI

Hangler H, Mueller L, Ruttmann E, Antretter H, Pfaller K. Shunt or snare: coronary endothelial damage due to hemostatic devices for beating heart coronary surgery. Ann Thorac Surg. 2008;86(6):1873–1877. doi: 10.1016/j.athoracsur.2008.06.047. PubMed DOI

Vural AH, Yalcinkaya S, Türk T, Yümün G, Gül N, Yalcinkaya U, Kaya M, Ozyazicioğlu A. Intracoronary shunt versus bulldog clamp in off-pump bypass surgery. Endothelial trauma: shunt versus clamp. J Surg Res. 2008;150(2):261–265. doi: 10.1016/j.jss.2007.12.774. PubMed DOI

Klein G, Kampmann M, Baum H, Rauscher T, Vukovic T, Hallermayer K, Rehner H, Müller-Bardorff M, Katus HA. Clinical performance of the new cardiac markers troponin T and CK-MB on the Elecsys 2010. A multicentre evaluation. Wien Klin Wochenschr. 1998;110(Suppl 3):40–51. PubMed

Babuin L, Jaffe AS, Troponin T. The biomarker of choise for the detection of cardiac injury. CMAJ. 2005;173(10):1191–1202. doi: 10.1503/cmaj/051291. PubMed DOI PMC

Bleier J, Vorderwinkler KP, Falkensammer J, Mair P, Dapunt O, Puschendorf B, Mair J. Different intracellular compartmentations of cardiac troponins and myosin heavy chains: a causal connection to their different early release after myocardial damage. Clin Chem. 1998;44(9):1912–1918. PubMed

Emmiler M, Kocogullari CU, Ela Y, Cekirdekci A. Influence of intracoronary shunt on myocardial damage: a prospective randomized study. Eur J Cardiothorac Surg. 2008;34(5):1000–1004. doi: 10.1016/j.ejcts.2008.08.002. PubMed DOI

Mingels A, Jacobs L, Michielsen E, Swaanenburg J, Wodzig W, van Dieijen-Visser M. Reference population and marathon runner sera assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and I assays. Clin Chem. 2009;55(1):101–108. PubMed

Apple FS, Jesse RL, Newby LK, Wu AH, Christenson RH, Cannon CP, Francis G, Morrow DA, Ravkilde J, Storrow AB, Tang W, Jaffe AS, Mair J, Ordonez-Llanos J, Pagani F, Panteghini M, Tate J. IFCC Comittee on Standardization of Markers of Cardiac Damage. National Academy of Clinical Biochemistry. National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes. Clin Chem. 2007;53:547–551. PubMed

Gumm DC, Cooper SM, Thompson SB, Marcus ML, Harrison DG. Influence of risk area size and location on native collateral resistance and ischemic zone perfusion. Am J Physiol. 1988;254(3 Pt 2):H473–H480. PubMed

Grünenfelder J, Comber M, Lachat M, Leskosek B, Turina M, Zünd G. Validation of Intracoronary Shunt Flow Measurements for Off-Pump Coronary Artery Bypass Operations. Heart Surg Forum. 2004;7(1):26–30. PubMed

Chavanon O, Perrault LP, Menasche P, Carrier M, Vanhoutte PM. Endothelial effects of hemostatic devices for continuous cardioplegia or minimally invasive operations. Ann Thorac Surg. 1999;68:1118–1120. doi: 10.1016/S0003-4975(99)00884-X. PubMed DOI

Izzat MB, Yim AP, El-Zufari MH. Snaring of a coronary artery causing distal atheroma embolization. Ann Thorac Surg. 1998;66:1806–1808. doi: 10.1016/S0003-4975(98)00929-1. PubMed DOI

Izutani H, Gill IS. Acute graft failure caused by an intracoronary shunt in minimally invasive direct coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(3):723–724. doi: 10.1067/mtc.2003.142. PubMed DOI

Najít záznam

Citační ukazatele

Nahrávání dat ...

Možnosti archivace

Nahrávání dat ...