Ann Thorac Surg 2005;79:1826
© 2005 The Society of Thoracic Surgeons
Correspondence
On Decreasing Distal Endothelial Damage After Intracoronary Shunt Insertion
Roland G. Demaria, MD, PhD,
Louis P. Perrault, MD, PhD
Department of Surgery and Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, PQ, H1T 1C8, Canada
(E-mail: lpperrau{at}icm.umontreal.ca).
To the Editor:
We read with interest the article by Hangler and colleagues [1] about the morphologic effects of intracoronary shunts on the coronary endothelial layer in the human beating heart. They have also described coronary lesions secondary to snare application in patients before heart transplantation and at scanning electron microscopy focal endothelial denudation, microthrombosis, and atherosclerotic plaque rupture [2]. We have reported a case of early multifocal stenosis at sites of coronary snaring after beating heart coronary artery surgery in a diabetic patient [3]. Our group has already shown that shunts caused a severe endothelial dysfunction, which can lead to acute spasm, thrombosis, or chronic intimal hyperplasia. Indeed, shunting to obtain hemostasis and a satisfactory intracoronary flow requires a snug fit that is systematically associated with a denudation and endothelial dysfunction [4]. Intracoronary shunts are associated with different disadvantages depending on their mismatch to the target coronary artery. The morphologic study of Hangler and colleagues [1] confirms our experimental findings.
We have recently proposed a new type of intracoronary shunt called the "Monoshunt" to avoid distal endothelial damage of the target coronary artery [5]. The Monoshunt has a distal undersized flexible portion that avoids rubbing on the endothelial layer and prevents occurrence of the endothelial dysfunction in the distal run-off while ensuring adequate hemostasis [6].
The perfect hemostatic systems for off-pump coronary artery bypass surgery, in terms of efficacy and particularly of safety, has not been discovered. Use of coronary hemostatic devices must always be guided by the concern of inducing as little trauma as possible with soft surgical handling and knowledge of potential complications.
 |
References
|
|---|
- Hangler HB, Pfaller K, Ruttmann E, et al. Effects of intracoronary shunts on coronary endothelial coating in the human beating heart Ann Thorac Surg 2004;77:776-780.[Abstract/Free Full Text]
- Hangler HB, Pfaller K, Antretter H, Dapunt OE, Bonatti JO. Coronary endothelial injury after local occlusion on the human beating heart Ann Thorac Surg 2001;71:122-127.[Abstract/Free Full Text]
- Demaria RG, Fortier S, Carrier M, Perrault LP. Early multifocal stenosis after coronary artery snaring during off-pump coronary artery bypass in a patient with diabetes J Thorac Cardiovasc Surg 2001;122:1044-1045.[Free Full Text]
- Demaria RG, Fortier S, Malo O, Carrier M, Perrault LP. Influence of intracoronary shunt size on coronary endothelial function during OPCAB Heart Surg Forum 2003;6:160-168.[Medline]
- 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;125:723-724.[Free Full Text]
- Demaria RG, Malo O, Carrier M, Perrault LP. The Monoshunt: a new intracoronary shunt design to avoid distal endothelial dysfunction during off-pump coronary artery bypass (OPCAB) Int Cardiovasc Thorac Surg 2003;2:281-286.[Abstract/Free Full Text]
Top
References