Securing the Distal Anastomosis Site: Coronary Artery Occlusion, Shunt, and Blower

Abstract

Obtaining an optimal anastomotic site is essential for successful OPCAB. Coronary artery occlusion is a simple and easy anastomotic technique. Regional myocardial ischemia rarely occurs during anastomosis. Intraluminal coronary shunts are safe, easy to handle, and useful for obtaining an optimal operative field and perfusing coronary artery as well. Extraluminal shunts are also useful for coronary perfusion. All three techniques have their own advantages and disadvantages. In the simple occlusion technique, occlusion of a large left anterior descending artery (LAD) with a small posterior descending artery and a LAD with mild stenosis can cause significant ischemic changes. Occlusion of right coronary artery (#2 to #3) sometimes causes life-threatening arrhythmia. In these cases, coronary perfusion is necessary. Although an intraluminal shunt can be used in most cases, insertion into a meandering coronary artery is difficult or even dangerous. The coronary artery might be injured or coronary perfusion may not be secured. An extraluminal shunt can secure adequate blood flow, although the tube might disturb the anastomosis. An extraluminal shunt can be used only for LAD and RCA. Carbon dioxide blower with saline mist is essential for obtaining bloodless operative field for off-pump coronary artery bypass grafting. These techniques should be selected properly for each case and coronary artery.