Thermosensitive Polymer Use for Shunt Sealing in Off-Pump Coronary Artery Bypass

Abstract

Objective To check the efficacy of a reverse thermosensitive gel (poloxamer P407) for intracoronary shunt sealing in off-pump coronary artery bypass surgery to stop residual bleeding from the shunt and avoid the use of blowers. Methods Nineteen coronary anastomoses were performed on five patients who underwent off-pump coronary artery bypass surgery. Intracoronary shunting was adopted in all procedures. All the shunts were sealed into the coronary lumen with the injection of a reverse thermosensitive gel. Before tying the sutures, a piece of ice was applied on the anastomotic sites to dissolve the gel. Bleeding from the coronary lumen was always checked after shunt removal. Results Bleeding was stopped or reduced and anastomoses performed without blower use. In one case, bleeding started again after shunt manipulation, and the shunt sealing procedure needed to be repeated. No intraoperative surface electrocardiogram and regional motion changes were detected. All patients showed normal creatine kinase-MB (CK-MB) levels in the postoperative period. All patients were free from adverse cardiovascular events at 4 months from operation. Conclusions The use of a thermosensitive polymer for intracoronary shunt sealing was effective in controlling bleeding, eliminated the necessity for blower use, and was not associated to operative complications.