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Ann Thorac Surg 2002;73:345
© 2002 The Society of Thoracic Surgeons

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Correspondence

Risk of coronary artery occlusion with snares during OPCAB: Reply

^a Department of Cardiovascular Surgery, National Taiwan University Hospital, 7 Chung-Shan S Rd, Taipei 100, Taiwan

To the Editor

We appreciate the comment from Dr Demaria and colleagues about the possible risk of our method of coronary occlusion. Various methods to obtain a bloodless field during off-pump coronary artery bypass (OPCAB) had been tried, including an internal occluder, internal shunt, circumferential suture around the target artery, and our method of a pledgeted parallel suture [1]. As Demaria and associates mentioned, we also had early local stenosis at the proximal site using circumferential snaring, which was proved by coronary recatheterization 3 months later. This is why we started to modify our method.

Although the figure in our article may look like vessel kinking, it is not what it looks like. In fact, the pericardium and epicardial fat beneath the pledget produce a cushion effect to prevent direct compression of the vessel. Our method spreads local compression pressure into several directions including the two pledgets and the distorted target vessel. Temporary coronary occlusion could be achieved by compression in any one direction, thus the total force does not focus at one point, which reduces a possible local effect.

In a "pipe-like" coronary artery, our method may not be suitable because of the possibility of rupture, as Demaria and coworkers described. Fortunately, most coronary arterial atheroma exists focally and eccentrically. The force of snaring remains important to prevent the possible vessel injury. Proper force of the snare in our method can reduce the risk of rupture. If the snare does not achieve a bloodless field a combination with an intracoronary shunt or occluder will produce adequate exposure and a clear operative field.

We thank Dr Demaria and colleagues for reminding us of the possible risk in our method. This allowed us the opportunity to explain in more detail.

References

1. Chen Y.S., Chou T.F., Lee J.Y., Lin F.Y., Wang S.S. New method of coronary artery occlusion for beating-heart coronary artery bypass surgery. Ann Thorac Surg 2001;71:1712-1713.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yih-Sharng Chen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lin, F.-Y. Articles by Chen, Y.-S. Search for Related Content PubMed PubMed Citation Articles by Lin, F.-Y. Articles by Chen, Y.-S. Related Collections Coronary disease Minimally invasive surgery Related Articles