Tok Mustafa, Ucar Halil I, Dogan Omer F, Farsak Bora, Yorgancioglu Ali C
Department of Cardiovascular Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
Saudi Med J. 2008 Apr;29(4):573-9.
To investigate if there are any advantages in using intracoronary shunts compared to shuntless operations, in the context of whether it has a protective role for the myocardia.
This prospective study, included 100 patients who underwent off-pump coronary bypass surgery at 2 different cardiovascular surgery departments, namely, the Social Security Ankara Ihtisas Hospital, and Hacettepe University Hospital, Turkey, between September 2002 and July 2006. Patients were divided into 2 groups. In group 1 n=50 off-pump coronary bypass operations were performed with intracoronary shunts. In group 2 n=50 shunts were not used during off-pump. Serum creatine kinase, myoglobin, and troponin were studied.
There were significant increases in serum creatine kinase levels in group 2 at postoperative 6th, 12th, and 24th hours. In group 2, the increase of myoglobin was statistically significant at only the postoperative 24th hour. Troponin levels were significantly higher in group 2 at postoperative 6th, 12th, and 24th hours.
There are some questions regarding myocardial protection while maintaining a bloodless secure surgical field in off-pump coronary surgery. However, use of intracoronary shunts provides distal coronary flow, and reduces the risk of myocardial ischemia, while maintaining a comfortable blood free anastomosis area.
在冠状动脉内分流术对心肌是否具有保护作用的背景下，研究与无分流手术相比，使用冠状动脉内分流术是否存在任何优势。
这项前瞻性研究纳入了2002年9月至2006年7月期间在土耳其安卡拉社会保障伊蒂萨斯医院和哈杰泰佩大学医院这两个不同心血管外科科室接受非体外循环冠状动脉搭桥手术的100例患者。患者被分为两组。第1组（n = 50）在非体外循环冠状动脉搭桥手术中使用冠状动脉内分流术。第2组（n = 50）在非体外循环手术期间未使用分流术。研究了血清肌酸激酶、肌红蛋白和肌钙蛋白。
第2组术后第6、12和24小时血清肌酸激酶水平显著升高。在第2组中，仅在术后第24小时肌红蛋白的升高具有统计学意义。第2组术后第6、12和24小时肌钙蛋白水平显著更高。
在非体外循环冠状动脉手术中，在保持无血安全手术视野的同时，关于心肌保护存在一些问题。然而，使用冠状动脉内分流术可提供冠状动脉远端血流，并降低心肌缺血风险，同时保持舒适的无血吻合区域。
