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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2006;132:1144-1149
© 2006 The American Association for Thoracic Surgery

Evolving Technology

Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicardial coronary arteries

Olivier Bouchot, MDa,*, Marie-Claude Aubin, MScb,*, Michel Carrier, MDc, William E. Cohn, MDd, Louis P. Perrault, MD, PhDb,c,*

a Department of Cardiovascular Surgery, Le Bocage Hospital, Dijon, France
b Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada
c Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
d Department of Surgery, Texas Heart Institute, Houston, Tex.

Received for publication February 2, 2006; revisions received April 5, 2006; accepted for publication April 24, 2006.

* Address for reprints: Louis P. Perrault, MD, PhD, Research Center, Montreal Heart Institute, 5000 Belanger St East, Montreal, Quebec H1T 1C8, Canada (Email: louis.perrault{at}icm-mhi.org).

OBJECTIVE: The aim of this study was to assess the efficacy of the novel reversible thermosensitive gel poloxamer 407 for occlusion of the coronary vessel necessary for minimally invasive operations and its effects on coronary endothelium.

METHODS: Domestic swine were submitted to occlusion of the left anterior descending or right coronary artery using the poloxamer. The left and right internal thoracic arteries were used as grafts to perform coronary artery bypasses. Animals were humanely killed after 3 hours of perfusion (acute; n = 8) or 3 days (subacute; n = 6). The vascular reactivity of coronary artery was evaluated in response to serotonin and bradykinin. Histologic studies were performed to analyze cardiomyocyte necrosis and endothelial coverage.

RESULTS: The gel led to an occlusion of 7.8 ± 2.2 minutes. Concentration-response curves of occluded coronary segments showed no difference of endothelium-dependent relaxations in both operated groups (P < .05 vs control). Histologic studies demonstrated the absence of cardiomyocyte necrosis after coronary artery occlusion in the acute group; a small infarct zone was detected in 1 animal in the subacute group, resulting from an occlusion of the first diagonal branch. The endothelial layer coverage was preserved in both groups.

CONCLUSION: The poloxamer 407 represents a promising technique for obtaining hemostasis at the site of anastomosis during construction of bypasses during beating heart coronary artery surgery, without damage to the endothelium or ischemic consequence.

Abbreviations and Acronyms BK = bradykinin; 5-HT = 5-hydroxytryptamine (serotonin); KCl = potassium chloride; LAD = left anterior descending coronary artery; OPCAB = off-pump coronary artery bypass grafting; P407 = poloxamer 407; RCA = right coronary artery




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