Intracoronary Shunt Prevents Ischemia in Off-Pump Coronary Artery Bypass Surgery Jacob Bergsland, MD, Per Snorre Lingaas, MD, Helge Skulstad, MD, PhD,

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Intracoronary Shunt Prevents Ischemia in Off-Pump Coronary Artery Bypass Surgery Jacob Bergsland, MD, Per Snorre Lingaas, MD, Helge Skulstad, MD, PhD, Per Kristian Hol, MD, PhD, Per Steinar Halvorsen, MD, Rune Andersen, MD, Milada Småstuen, PhD, Runar Lundblad, MD, PhD, Jan Svennevig, MD, PhD, Kai Andersen, MD, PhD, Erik Fosse, MD, PhD The Annals of Thoracic Surgery Volume 87, Issue 1, Pages 54-60 (January 2009) DOI: 10.1016/j.athoracsur.2008.08.032 Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transesophageal echocardiographic four-chamber view recording. Tissue velocities are color coded: red signifies motion toward the echocardiography probe, and blue represents motion away from the echocardiography probe. (IVS = interventricular septum; LA = left atrium; LV = left ventricle; LW = left ventricular lateral wall.) The Annals of Thoracic Surgery 2009 87, 54-60DOI: (10.1016/j.athoracsur.2008.08.032) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Strain curves from the apical septum in 2 different patients. Recordings shown demonstrate strain curves before left anterior descending artery (LAD) occlusion, at 1 minute of occlusion and at 5 minutes of occlusion. In the upper panel, it is demonstrated that ischemia appeared, reflected by positive strain values, as the LAD was occluded during shunt implantation. However, the ischemia disappeared as the shunt reestablished the LAD flow. In the patient without shunt (lower panel), ischemia continued till the time of reperfusion. Strain after reperfusion is not shown. The Annals of Thoracic Surgery 2009 87, 54-60DOI: (10.1016/j.athoracsur.2008.08.032) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Mean arterial pressure (MAP [open squares = no shunt; solid squares = shunt]) and cardiac output (open diamonds = no shunt; solid diamonds = shunt) at baseline, during grafting, and after reperfusion. The Annals of Thoracic Surgery 2009 87, 54-60DOI: (10.1016/j.athoracsur.2008.08.032) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions