Initial experience using an intraluminal shunt during revascularization of the beating heart.

Abstract

For decades, surgeons have relied on extracorporeal circulation and induced cardiac asystole to provide a bloodless, motionless field in which to construct coronary bypass grafts. However, the technique of coronary grafting without heart-lung support is now being revitalized. The current resurgence of off-pump coronary artery bypass grafting and the advent of less invasive incisions make it imperative that technical advances be applied to maximize the safety of these procedures. This report describes an inexpensive intraluminal shunt that maintains coronary perfusion, prevents ischemia, reduces backbleeding, and molds the suture line to prevent accidental missuturing of the posterior coronary wall. In 63 patients, saphenous grafts were placed to the left anterior descending (49), diagonal (9), and right coronary artery (27) without extracorporeal circulation using an intraluminal shunt. There were no deaths (0% mortality) and one perioperative infarction (1.5%). Complication and graft patency rates were comparable with those obtained by conventional techniques. Temporary intraluminal shunting greatly facilitates the surgeons' operative environment by permitting safe and precise construction of coronary artery grafts on the beating heart in a bloodless field. Intraluminal shunting may have future implications on the ability to perform safe and reproducible grafting on the beating heart through minimally invasive or endoscopic approaches.