Effects of the self-myocardial retroperfusion with aortic-coronary sinus shunt on cardiac output and ischemic events in high-risk patients undergoing OPCAB surgery.

Aim: Despite controversies, off-pump coronary artery bypass (OPCAB) surgery has become a routine procedure. Obvious advantages have been demonstrated in high-risk patients. However, OPCAB surgery has limitations in specific high-risk situations with hazards of operative deleterious events. We describe an innovative procedure of self-myocardial retroperfusion (SMR) with an aortic-coronary sinus shunt (ACSS). We prospectively evaluated the protective effects and benefits of SMR in high-risk coronary patients with impaired LVEF.

Methods: Eighteen consecutive high-risk (ES>10) coronary patients (mean age: 65.94 years; range: 34-85; mean ES: 26.97%) with LVEF≤35% who were not eligible for IABP were assigned for OPCAB surgery. Following sternotomy, the cardiac indexes (CI) were measured before, during SMR and after completion of coronary artery bypasses. Operative events with and without SMR were accurately collected, and postoperative cardiac Troponin T release was measured.

Results: OPCAB procedures were performed in all patients. Intraoperative use of SMR significantly increased CI (P=3.1041810.10-8) and reversed deleterious operative events (ECG changes/low cardiac output). Hospital mortality was 0%. Incidence of transient atrial fibrillation was 33.33%. Neither stroke nor renal insufficiency was observed. The mean graft number/patient was 2.05. Mean postoperative cardiac Troponin T value was 0.79 μg/L. Beating heart preservation optimized by SMR contributed to reduce ischemia-reperfusion injury, as validated by an immediate increase of CI after completion of coronary bypasses (P=3.35009.10-9).

Conclusion: The concept of SMR with an ACSS during OPCAB procedures definitely improved CI and reversed ischemic features in high-risk patients and should be considered as an operative temporary myocardial assistance.