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J Thorac Cardiovasc Surg 2007;133:1397
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Temporary coronary artery occlusion during off-pump surgery and endothelial vessel dysfunction: Is it still an unresolved mystery?

^a Cardiochirurgia, UDA, Università di Brescia, Brescia, Italy
^b Department of Cardiovascular Surgery, University of Padua Medical School, Padua, Italy

(Email: bottio{at}med.unibs.it).

To the Editor:

We read with great interest the article by Bouchot and associates.¹ We would like to congratulate the authors for this well-designed study, but we would also add some comments. The aim was to determine the usefulness and safety of the poloxamer P407 gel (LeGoo; Pluromed, Woburn, Mass) to ensure a hemostatic effect at the anastomotic site during off-pump surgery in a porcine model. Twenty Landrace Yorkshire pigs, after median sternotomy, underwent internal thoracic artery off-pump grafting to the left anterior descending artery, the right coronary artery, or both by using the P407 gel to control the anastomotic-site bleeding. The major finding of the study was that the intracoronary injection of P407 gel allows a successful occlusion of the coronary vessel during grafting while preserving the endothelial function. The main limitation of the study protocol is essentially related to the health of the coronary artery tree used as a benchmark. Therefore, the presence of native atherosclerotic lesions might indicate the presence of further and otherwise undiscovered intimal injuries.

We maintain that shunting and snaring during off-pump coronary artery bypass grafting are both risky procedures,² and thus the opportunity to use a gel effective in bleeding control without impairing the endothelial function might have a relevant effect on coronary artery bypass grafting surgery. Therefore, because there is a higher hazard of damage to the coronary wall during vessel manipulation with a more diseased atherosclerotic vessel, we suggest that testing the gel effects on the coronary arteries of patients affected by ischemic cardiomyopathy before heart transplantation and before the start of cardiopulmonary bypass should additionally be performed.

As clinicians continuing to educate ourselves on the benefits of new technologies, we conclude that a more carefully conducted study on a human model might resolve the issue of whether one technique is more suitable than another.

References

1. Bouchot O, Aubin MC, Carrier M, Cohn WE, Perrault LP. Temporary coronary artery occlusion during off-pump coronary artery by-pass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicardial coronary arteries. J Thorac Cardiovasc Surg. 2006;132:1144-1149.[Abstract/Free Full Text]
   
2. Gerosa G, Bottio T, Valente M, Thiene G, Casarotto D. Intracoronary artery shunt: an assessment of possible coronary artery wall damage. J Thorac Cardiovasc Surg. 2003;125:1160-1162.[Free Full Text]
   

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): Tomaso Bottio Gino Gerosa Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bottio, T. Articles by Gerosa, G. Search for Related Content PubMed PubMed Citation Articles by Bottio, T. Articles by Gerosa, G. Related Collections Myocardial protection Related Article