Coronary clamping versus shunting during off pump CABG, early experience and outcome

Background

The aim of this study was the evaluation of safety and outcome of temporal clamping of coronary artery in comparison to intraluminal coronary shunting, during distal anastomosis in off-pump coronary artery bypass grafting (CABG).

Methods

To evaluate the early outcome of coronary clamping, we randomly compared the results of 25 patients submitted to coronary clamping using microvascular clamps during off-pump CABG (group A), with the results of another 25 patients had traditional intraluminal coronary shunting during same procedure (group B). All patients proved to have coronary artery disease with no difference between the groups in preoperative clinical variables.

Results

Clamp group (A) had significant shorter operative time than shunt group (B); it was 224.2 ± 44.1 min in group (A) versus 250.4 ± 33.7 in group (B).

Our new coronary clamp was applied in (93%) of target vessels but coronary shunt was implanted in (96%) of target vessels during distal coronary anastomosis.

Clamp group (A) had low number of patients who required inotropic support (adrenaline > 0.15 μg/kg/min) > 24 Hours during perioperative period. The study showed two cases of mortality in both groups.

At 6 months follow up; no difference between both groups was found, but late postoperative ejection fraction in group (A) was better, when compared to group (B).

Conclusions

Temporal coronary clamping technique may be used as an applicable option to create a bloodless field during off-pump CABG surgery. It seems to be faster and cheaper than intraluminal shunting. Also, it has the same complications, mortality and ICU stay.