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Chapter category: Heart

Effects of Vascular-Interrupting and Hemostatic Devices on Coronary Artery Endothelial Function in Beating Heart Coronary Artery Bypass Surgery

Chapter authors:
Roland G. Demaria and Louis P. Perrault

Coronary artery bypass grafting was first conceived and experimented on by the French Nobel Prize winner in Medicine Alexis Carrel at the beginning of the previous century. 1 Sabiston, in 1962, performed the first aortocoronary venous bypass graft in humans, and Kolesov, the first left internal mammary artery (IMA) to left anterior descending (LAD) coronary artery in 1966.2,3 All these operations were undertaken on the beating heart. At the end of the 1960s, Favaloro and the Cleveland Clinic team launched the era of modern coronary artery bypass surgery with the use of the extra-corporeal circulation.4 All these pioneers were confronted by the problem of blood flow control at the anastomotic site. Different techniques, such as compression, irrigation of the area or external cross-clamping with poor stabilization were tried. Rapidly, cardiopulmonary bypass (CPB) was almost universally adopted for coronary bypass surgery, allowing surgeons to achieve a bloodless and motionless operative field. The majority of coronary operations were soon performed with this technique, and beating heart coronary revascularization was abandoned as a routine procedure. Because CPB caused a major systemic inflammatory response with subsequent risks of hemorrhagic and neurological complications, and perhaps for economic reasons, some surgical teams remained faithful to the technique and were involved in its revival. In the last decade, beating heart coronary artery bypass surgery has regained tremendous popularity in the cardiovascular community.5,6 Nevertheless, specific technical difficulties are still associated with this approach; heart stabilization or coronary bleeding at the anastomotic site. These issues may alter the quality of anastomosis and result in a greater need for reoperation or percutaneous coronary angioplasty.7 Therefore, the ideal technique to obtain a bloodless field on coronary anastomotic sites, mandatory for the surgeon’s optimal visualization, remains unresolved.

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