The Heart Surgery Forum, Volume 6, Issue 6

A Novel Custom-Made Long Shunt Simplifies the Performance and Improves the Results of Beating-Heart Surgery

(#2003-612938 . . . August 28, 2003)

Donald E. Ross

Royal North Shore Hospital, Sydney, Australia

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ABSTRACT

Background: The occurrence of a snare-related stenosis after beating-heart surgery prompted the search for an alternative method of hemostasis. Because of the shortcomings of commercial coronary shunts a novel custom-made coronary shunting technique was devised. It involves the use of varying lengths of 1.2-mm Silastic tubing secured with a fine silk "tag" suture. The technique of construction and deployment of the shunts is presented. A retrospective comparison of 500 off-pump coronary artery bypass graft (OPCAB) cases done with snares was made with 300 cases using custommade long shunts (CLS).

Method: Between June 1998 and December 2000, 500 OPCAB surgeries were done using the Platypus stabilizer and Silastic snares for hemostasis. Thereafter, 300 surgeries were done with the same stabilizer but using CLS instead of snares.

Results: The CLS group had a perioperative infarction incidence of 1.6% compared with 4.4% in the snare group. Other measured parameters remained unchanged, but there was a profound, but subjectively noted, reduction in the incidence of hemodynamic instability in the shunted cases.

Conclusion: The best method for control of coronary bleeding during beating-heart surgery remains controversial. There is increasing evidence that snares can cause artery damage and spasm. Shunting avoids this problem while enhancing hemodynamic stability and facilitating accurate anastomoses. The case against shunts is based mainly on inconvenience but this problem has been substantially negated by the introduction of the CLS technique.

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