The impact of the apelinergic system in coronary collateral formation.

Background: This study aims to examine the relationship between the development of coronary collateral circulation and serum elabela levels. Methods: Between January 2020 and December 2021, a total of 50 control individuals (29 males, 21 females; mean age: 63.2±10.0 years; range, 52 to 73 years) with no significant coronary artery disease as confirmed by angiography (Group 1) and 100 patients (55 males, 45 females; mean age: 66.6±9.6 years; range, 56 to 75 years) with coronary artery disease were included. The patients were further divided into two equal groups according to the Rentrop classification as poor (Group 2) and good coronary collateral circulation (Group 3). All groups were compared in terms of several parameters, particularly serum elabela levels. Results: Serum elabela levels were found to be statistically higher in the group with good collateral than the other groups (p<0.05). Low serum elabela levels increased the risk of developing weak collaterals by 2.43 times. Conclusion: The elabela protein is directly related to good collateral development and can be considered a potential agent for treatment.

Incidental diagnosis of ochronosis by aortic valve replacement.

Alkaptonuria is a rare inherited metabolic disease caused by homogentisic acid oxidase enzyme deficiency. Homogentisic acid formed during phenylalanine and tyrosine metabolism cannot be further metabolized and accumulates due to this enzyme deficiency. Some of the homogentisic acid that cannot be removed by metabolism is excreted with urine, some of it causes this accumulation known as ochronosis, which is characterized by dark pigmented color change in tissues. The classic clinical triad of the disease is darkening of the urine color, degenerative arthritis in the joints and dark colored pigmentation in the connective tissue. Herein, we present a case of ochronosis detected incidentally during aortic valve replacement with the diagnosis of aortic insufficiency.

Anatomical and functional changes after aortic valve replacement with different sizes of mechanical valves.

OBJECTIVE: To date, there is no consensus on the selection of type and size of prosthetic valve for aortic valve replacement (AVR). The aim of this study was to compare anatomical and functional changes occurring in the left ventricle after AVR with different sizes of mechanical valves. METHODS: A total of 92 patients with serious aortic valve stenosis, who underwent AVR between March 2001 and June 2008 using mechanical valves of different sizes, were retrospectively analysed. The sizes of the mechanical valves were 19, 21, 23 and 25 mm. All patients were assessed preoperatively, and at six months and in the first, third and fifth years postoperatively. The left ventricle was assessed with electrocardiography, echocardiography and telecardiography and compared in the four patient groups, constituted according to the mechanical valve size used. RESULTS: In all groups, left ventricular mass and mass index, transvalvular aortic gradient, thicknesses of the interventricular septum and posterior wall, and left ventricular endsystolic and end-diastolic diameters had decreased significantly post surgery. Left ventricular ejection fraction and exercise capacity had increased significantly (p < 0.001). The most noteworthy anatomical and functional improvements were seen in patients who had received 23- and 25-mm mechanical valves. CONCLUSION: Mechanical valve replacement should not be performed with small size valves because of the higher residual gradient.

Coronary artery bypass surgery: beating heart or cardiopulmonary bypass?

In this study, we examined the early results for patients who underwent beating heart coronary bypass surgery and compared these results with those of conventional coronary bypass surgery.A total of 1094 patients who underwent isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic were included in this study. Seventy-three patients in whom cardiopulmonary bypass was not used (group 1) were compared to 1021 patients in whom cardiopulmonary bypass was used (group 2).The mean age was 60.7 ± 9.3 in group 1 and 58.9 ± 9.7 in group 2 (P > 0.05). There was no significant difference between the two groups in terms of gender, or the coexistence of diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and hypertension (P > 0.05). There was no significant difference between group 1 and group 2 in terms of development of postoperative atrial fibrillation (AF), use of an intra-aortic balloon pump, need for re-operation for bleeding, or duration of hospital stay and intensive care unit stay (P > 0.05). The need for inotropic support and the amount of mediastinal drainage were less in group 1 than in group 2 (P = 0.002, P < 0.001). The incidences of postoperative cerebrovascular accident, development of chronic renal failure, and sternal wound infection did not significantly differ between the groups (P > 0.05). There was no mortality in group 1, whereas it was calculated as 1.8% in group 2 (P = 0.63).Beating heart coronary artery bypass surgery decreases the need for inotropic support and transfusion.

Early postoperative results for females undergoing isolated coronary artery bypass surgery: comparison of the pre- and postmenopausal periods.

PURPOSE: In this retrospective study, we investigated the demographic data and evaluated our early postoperative results of premenopausal and postmenopausal females who underwent coronary artery bypass graft surgery (CABG). METHODS: A total of 730 female patients who underwent CABG between April 2004 and January 2012 were included in the study. Patients were divided into two groups based on whether they were pre- (group 1) or postmenopausal (group 2). The groups were compared in terms of the demographic and peri-operative parameters. RESULTS: Smoking and the preoperative hematocrit levels were higher in group 1, whereas the incidence of hypertension and obesity and the European system for cardiac operative risk evaluation values were higher in group 2 (p values <0.01; <0.01; <0.01; 0.004 and <0.01 respectively). The utilization of a left internal mammary artery graft and the postoperative drainage volumes were higher in group 1; however, the number of grafts per patient, cardiopulmonary bypass duration, number of patients who needed inotropic support, blood transfusion volumes, the duration of ventilatory support and the hospital stay were higher in group 2 (p values 0.038; 0.040; 0.026; 0.032; 0.014; 0.001; <0.01 and <0.01, respectively). CONCLUSIONS: Although the mortality rates were not significantly different, postmenopausal patients require more intensive postoperative care in comparison to premenopausal patients following CABG.

The effect of gender on the early results of coronary artery bypass surgery in the younger patients' group.

INTRODUCTION: In this retrospective study, we aimed to determine the risk factors for coronary artery bypass surgery in patients under 45 years of age, and evaluate the early postoperative results and the effect of gender. METHODS: A total of 324 patients under 45 years of age who undergone on-pump coronary artery bypass surgery between April 12, 2004 and January 10, 2012 were included to the study. Patients divided into groups as follows: Group 1 consisted of 269 males (mean age 41.3), Group 2 consisted of 55 females (mean age 41.6). Preoperative risk factors, intraoperative and postoperative data and early mortality rates of the groups were compared. RESULTS: Smoking rate was significantly higher in Group 1. Diabetes mellitus incidence and body mass index were significantly higher in Group 2 (P values P=0.01; P=0.0001; P=0.04 respectively). The aortic cross-clamping and cardiopulmonary bypass time and number of grafts per patient were significantly higher in Group 1 (P values P=0.04; P=0.04; P=0.002 respectively). There were no deaths in either group. CONCLUSION: We found that gender has no effect on early mortality rates of the coronary bypass surgery patients under 45 years.

Hybrid repair of aortic arch aneurysms in same session.

BACKGROUND: Management of thoracic aorta aneurysms-especially the ones including aortic arch-is highly complicated. Isolated or nonisolated aortic arch aneurysms can be repaired by hybrid procedure especially in patients with comorbidities as well as by conventional open methods. METHODS: Eleven patients who underwent total arch debranching and endovascular stent implantation on antegrade route in the same session between November 2006 and October 2009 were retrospectively evaluated using clinical and perioperative criteria. RESULTS: The mean age was 65 ± 6.2 and nine of the patients were male. Primary technical success rate was 100%. Mortality, stroke, or transient paraplegia/paraparesia was not seen during in-hospital follow-up. Average follow-up period was 36 ± 13 months and no late-term aortic pathology was seen. In only one of the patients, endovascular reintervention was required for type 1B endoleak. No mortality or neurological pathology was seen in long-term postoperative follow-up. CONCLUSION: Hybrid procedures could be performed safely with lower complication and higher success rates in the same session via antegrade route and zone 0 graft deployment for high-risk cases with isolated or nonisolated aortic arch aneurysms.

Off-pump coronary artery bypass surgery in patients with coronary artery disease and malign neoplasia: results of ten patients and review of the literature.

Cardiopulmonary bypass has been reported to have many effects on the immune system. The aim of this study was to investigate the efficiency and usefulness of off-pump coronary artery bypass (OPCAB) surgery on patients who had coronary artery disease besides malign neoplasia. We applied OPCAB operations to 217 patients between March 2001 and April 2004, ten of whom had malign neoplasia. These patients were diagnosed to have coronary artery disease on their routine examination for their oncologic operation. The malignancies were stomach cancer (2 patients), colon-rectum carcinoma (3 patients), breast carcinoma (2 patients), surrenal carcinoma (1 patient), larynx carcinoma (1 patient), and meningioma (1 patient). The patients were operated on for their neoplasia by the related clinics at a mean of 42 days after the OPCAB surgery. The patients were discharged with surgical success and without any cardiac complications. Coronary artery bypass surgery before a noncardiac major operation may effectively decrease the long-term mortality due to myocardial ischemia. Severe coronary artery disease should be surgically treated in those patients who are scheduled to undergo an operation for malign neoplasia. Extracorporeal circulation impairs the immune system and negatively affects the defense of host against malignancy. Therefore, patients with severe coronary artery disease who are candidates for oncologic operation should be treated with OPCAB.

Giant extracardiac unruptured sinus of Valsalva aneurysm in a patient with left ventricular dysfunction.

Extracardiac unruptured sinus of Valsalva aneurysm (SVA) is an infrequent cardiac anomaly. Unruptured SVAs are typically symptom-free until rupture occurs. We describe a case of an unruptured extracardiac SVA originating from noncoronary sinus with left ventricular dysfunction. The patient was asymptomatic. The diagnosis was made by transthoracic echocardiography, computed tomography, and cardiac catheterization. The aneurysm was surgically resected and the sinus was successfully reconstructed with a patch. The patient remained asymptomatic throughout the postoperative follow-up period. Early surgical repair should be the choice of treatment for extracardiac SVAs in order to prevent sudden death.

Surgical treatment of postinfarction left ventricular pseudoaneurysms.

OBJECTIVE: Left ventricular pseudoaneurysm is a rare but serious complication of acute myocardial infarction. It is under debate whether surgical intervention is mandatory in asymptomatic patients. The aim of this report was to present our experience based on surgical treatment and midterm outcomes of patients with postinfarction left ventricular pseudoaneurysm. METHODS: Eight consecutive patients who underwent left ventricular pseudoaneurysm operation between January 1, 1995, and January 1, 2006, were included in the study. There were 5 male and 3 female patients. Mean age was 62.87 +/- 5.03 years. All patients had echocardiography and coronary angiography before the operation. Two anterior and 6 posterior pseudoaneurysms were detected. Left ventricular pseudoaneurysm was repaired with a synthetic patch by the remodeling ventriculoplasty method of Dor in all patients. Coronary revascularization was performed if necessary. Preoperative, operative, and postoperative data were collected from the patient cohorts. RESULTS: The mean duration from myocardial infarction to diagnosis of the ventricular septal rupture was 13.5 +/- 12 days. Additional coronary artery bypass surgery was performed with a median of 1.2 grafts in 5 patients (62.5%). The mean postoperative mechanic ventilator support time was 20.12 +/- 29.22 hours. Overall 30-day mortality was 12.5% with 1 patient death. The mean intensive care unit stay was 3.75 +/- 2.1 days. The late mortality rate was 12.5%. In the follow-up period (mean, 30.66 +/- 16.86 months), of the 6 patients who were alive, 5 were in New York Heart Association class I or II and 1 was in class III because of pre-existing low left ventricular ejection fraction. Transthoracic echocardiography showed good left ventricular configurations without a false aneurysm together with increases in the ejection fractions. CONCLUSION: Prompt diagnosis and early surgical intervention is essential for patients with large or expanding left ventricular pseudoaneurysms due to the high propensity of fatal rupture. Associated coronary artery bypass grafting may reduce early mortality of patients with left ventricular pseudoaneurysm by resuscitating the ischemic myocardium.

Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion.

Antegrade selective cerebral perfusion through the right axillary artery has proved to be a safe and effective method for cerebral protection in aortic surgery. In this study, we prospectively evaluated the techniques of direct right axillary artery cannulation (Group 1) and right axillary artery side-graft cannulation (Group 2), investigated cannulation-related complications, and determined the hemodynamic advantages and disadvantages of both cannulation techniques. Sixty-eight patients underwent surgery from April 2001 through August 2004 with the diagnoses of ascending and aortic arch aneurysms (10 patients), type A aortic dissection (56 patients), and aortic pseudoaneurysm (2 patients). There were 22 patients in Group 1 (33.4%) and 46 patients in Group 2 (67.6%). The antegrade selective cerebral perfusion flow was 500 to 700 mL/min in Group 1, whereas in Group 2 the flow was adjusted in accordance with the mean right radial arterial pressure, which was 50 mmHg. There was no significant difference between the groups in antegrade selective cerebral perfusion times, but the transient neurologic dysfunction rate (4 of 22 patients in Group 1 vs 1 of 42 in Group 2) was significantly lower in Group 2 (P =0.035). In Group 1, axillary artery dissection occurred in 2 patients (9%), and postoperative arm ischemia occurred in 1 patient (4.5%). These complications were not seen in Group 2 (P =0.031). The side-graft cannulation technique may be more acceptable because of its lower local-complication rate and because it provides pressure-controlled cerebral perfusion.

Um sistema de ventrículo pulmonar produzindo pressão pulsátil em único ventrículo: modelo experimental / A pulmonary ventricle system producing pulsatile pressure in single ventricle: experimental model

OBJETIVO: Pacientes com ventrículo único funcional têm prognóstico ruim, que resulta em insuficiência cardíaca, mesmo após tratamento cirúrgico. As operações derivação cavo-pulmonar (exceto pelas conexões do átrio direito ao ventrículo direito) não apresentam sistema ventricular pulmonar com pressão pulsátil, além do fluxo reduzido ao ventrículo único. Para resolver o problema, tentamos criar um ventrículo pulmonar que produza pressão pulsátil experimentalmente. MÉTODO: Tentamos criar um sistema ventricular direito que produzisse pressão pulsátil. O modelo experimental foi realizado em seis ovelhas. As pressões do ventrículo pulmonar criado, da artéria pulmonar e do ventrículo esquerdo foram medidas após a saída da circulação extracorpórea. RESULTADOS: A média das pressões arteriais pulmonares sistólica e diastólica foi 15,6 ± 2,0 mmHg e 4,5 ± 1,5 mmHg. A média da pressão sistólica ventricular esquerda foi 76,6 ± 4,4 mmHg. CONCLUSÃO: Um ventrículo que produza pressão pulsátil é necessário para a regulação do fluxo da artéria pulmonar, com pressão venosa central e pressão pulmonar não pulsátil nas anomalias como ventrículos únicos funcionais.

OBJECTIVE: Patients with functional single ventricle show bad survey, most of which result in cardiac failure even in the case that they are operated. The right heart bypass operations except for right atrium and right ventricle connections lack pulsatile pulmonary ventricle system besides the volume lack coming to the common ventricle. To solve the problem, we tried to create a pulmonary ventricle which produces pulsatile pressure experimentally. METHODS: We tried to form a right ventricle system which produces pulsatile pressure. The experimental model was carried on six sheep. The pressures of the created pulmonary ventricle, pulmonary artery and the left ventricle were measured after leaving the cardiopulmonary bypass. RESULTS: The mean of the systolic and diastolic pulmonary artery pressures were 15,6 ± 2.0 mmHg and 4.5 ± 1.5 mmHg. The mean of the left ventricular systolic pressure was mean 76.6 ± 4.4 mmHg. CONCLUSION: A ventricle producing pulsatile pressure is necessary for regulating the pulmonary artery flow with high central venous pressure and low non-pulsatile pulmonary pressure in the anomalies with functional single ventricles.

Repair of post-infarct ventricular septal rupture with an infarct-exclusion technique: early results.

BACKGROUND: Ventricular septal rupture is a rare but life-threatening complication of acute myocardial infarction. The mortality rate with medical treatment is more than 90%, whereas the mortality rate after surgical repair varies between 19% and 60% in different studies. This study reviews our experience based on early closure of the septal rupture with an infarct-exclusion technique. METHODS: Eighteen consecutive patients who underwent post-infarct ventricular septal rupture operation between June 1, 2000, and November 1, 2005, were included in the study. There were 12 male and 6 female patients. Mean age was 65.72 +/- 5.21 years. All patients had echocardiography and coronary angiography before the operation. Rupture was closed with an infarct-exclusion technique in all patients. Preoperative, operative, and postoperative information were collected from patient cohorts. RESULTS: The median time from myocardial infarction to diagnosis of the ventricular septal rupture was 4.22 +/- 1.61 days. Fourteen of the patients had intra-aortic balloon pump support, and 5 had mechanic ventilator support preoperatively. Surgical repair was done 1 to 4 days after the diagnosis. Ten anterior and 8 posterior ventricular septal ruptures were found. Additional coronary artery bypass surgery was performed with a median of 1.27 +/- 0.8 grafts in 15 (83.3%) patients. The mean postoperative mechanic ventilator support time was 34.13 +/- 45.11 hours. Overall 30-day mortality was 16.7% with 3 patients. The mean intensive care unit stay was 3.3 +/- 1.6 days. Postoperative transthoracic echocardiography showed minimal residual shunts in 4 patients. CONCLUSION: Patch closure of the ventricular septal rupture with an infarct-exclusion technique provided acceptable results. Concomitant coronary artery bypass grafting might be beneficial to control additional risk of an associated coronary artery lesion. Prompt diagnosis followed by early surgical intervention is essential for patients with ventricular septal rupture.

Aortic valve replacement in true severe aortic stenosis with low gradient and low ejection fraction.

OBJECTIVE: The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction

Whole-body perfusion under moderate-degree hypothermia during aortic arch repair.

INTRODUCTION: There continue to be some controversies concerning aortic arch reconstruction, especially the cerebral protection methods. We report our operative and postoperative outcomes for cases of aortic arch replacement using whole-body perfusion during aortic reconstruction under 28 degrees C moderate hypothermia. MATERIALS AND METHODS: A total of 12 patients were operated on between March 2003 and November 2005. Two of the patients were female. The mean age of the patients was 53.5 x 7.3 years (range, 42-65 years). We cannulated the right axillary artery for cerebral perfusion and the right femoral artery for body perfusion. Arch replacement was done under continuous antegrade cerebral perfusion through the right axillary artery and continuous body perfusion through the right femoral artery via intra-aortic occlusion of the proximal descending aorta with an intra-aortic occlusion catheter. Perioperative data and postoperative outcomes, blood urea nitrogen, serum creatinine, and alanin aminotransferase values were evaluated retrospectively in the patients. RESULTS: There was only 1 hospital mortality. There were no neurologic complications. Postoperative levels of blood urea nitrogen and creatinin did not show significant difference but the alanin aminotransferase levels were significantly higher in the postoperative period, which was within the normal ranges of cardiopulmonary bypass effect. DISCUSSION: Whole-body perfusion through the axillary and femoral arteries may provide more time for the surgeon and good cerebral and visceral protection, which are especially important for surgical teams in the learning curve.

Surgical treatment of prosthetic valve thrombosis: ten years' experience.

BACKGROUND AND AIM OF THE STUDY: Prosthetic valve thrombosis (PVT) is a rare, but serious, complication of heart valve replacement with a mechanical substitute. Herein is presented the authors' surgical experience of 18 patients with PVT. METHODS: A total of 1,584 heart valve operations was performed in 1,365 patients at the authors' institution between June 1995 and September 2005. Surgical reports of prosthetic valve reoperations over the same period were screened. Preoperative, operative and postoperative data were collected from the patient cohorts. RESULTS: Since July 1997, 18 patients (12 females, six males; mean age 35.9 +/- 11.3 years; range: 22-60 years) presented with PVT. The subtherapeutic anticoagulation level was the major etiologic factor involved in the pathogenesis of PVT. Thrombosis occurred in the mitral position in 14 patients (78%), and in the aortic position in four (22%). All mechanical valves implanted were bileaflet (1,097 St. Jude Medical, 324 CarboMedics, and 163 Sorin). The mean duration from valve replacement to PVT was 48.3 +/- 15.4 months. The majority of patients presented with poor functional status (56% in NYHA class IV) and poor anticoagulation (INR < or = 2 in 72% of cases). Valve re-replacement was performed for all patients. The 30-day mortality was 16.7%. CONCLUSION: PVT is a potentially fatal complication of heart valve replacement. These acceptable results suggest that early surgical intervention might be a safe and effective treatment of choice in patients with PVT. Patients with mechanical valve prostheses should be informed adequately about the need for, and the importance of, an effective anticoagulation regimen.

A novel multi-planed mechanical aortic valve for increasing the effective orifice area.

BACKGROUND: Today, there is still confusion about mismatch of the orifice area of the mechanical valve and body surface area of the patient in aortic valve surgery. Creating a larger effective orifice area is the aim with this new valve design. METHOD: This valve is multi-planed, one housing is seated at the aortic annulus for the coronary orifices to receive blood in diastole, the other housing or housings are seated to the ascending aorta obliquely to increase the orifice area of the valve. The ascending aorta can be enlarged if necessary. RESULT: Valves with orifice areas larger than 6 cm(2) can be achieved with multi-planed aortic valves. DISCUSSION: The use of this valve depends on the fact that the aorta is a living tissue and can grow over time to normal values.

Traumatic brachial artery injuries.

We performed this retrospective study to analyze our strategies for managing and surgically treating brachial artery injuries. Fifty-seven patients with a total of 58 traumatic brachial artery injuries underwent surgery at our institution, from August 1996 through November 2004. Fifty-four patients were male and 3 were female (age range, 7 to 75 years; mean, 29.4 years). Forty-four of the patients had penetrating injuries (18 had stab wounds; 16, window glass injuries; and 10, industrial accidents), 10 had blunt trauma injuries (traffic accidents), and 3 had gunshot injuries. Fourteen patients (24.6%) had peripheral nerve injury. All patients underwent Doppler ultrasonographic examination. The repair of the 58 arterial injuries involved end-to-end anastomosis for 32 injuries (55.2%), reverse saphenous vein graft interpositional grafts for 18 (31%), and primary repair for 8 (13.8%). Venous continuity was achieved in 11 (84.6%) of 13 patients who had major venous injuries. Nine of the 57 patients (15.8%) required primary fasciotomy. Follow-up showed that 5 of the 14 patients with peripheral nerve injury had apparent disabilities due to nerve injury. One patient underwent amputation. There were no deaths. We believe that good results can be achieved in patients with brachial artery injuries by use of careful physical examination, Doppler ultrasonography, and restoration of viability with vascular repair and debridement of nonviable tissues. Traumatic neurologic injury frequently leads to disability of the extremities.

The progress of mitral regurgitation after isolated coronary artery bypass in cases of ischemic mitral regurgitation.

BACKGROUND: Mitral valve intervention combined with coronary artery bypass surgery is inevitable in the case of severe mitral regurgitation in patients with coronary artery disease because the prognosis is poor without mitral correction. The best treatment protocol for patients with a moderate degree of mitral regurgitation is under debate. To clarify the optimal management for these patients, we evaluated the progress of mitral regurgitation after isolated coronary artery bypass surgery in cases of ischemic mitral regurgitation. METHODS; The study was conducted between March 2001 and April 2003. Forty-seven patients (70% men, with a mean age of 61 years, a mean ejection fraction of 43.7%, and a mean New York Heart Association class of 2.53) with preoperative diagnoses of moderate degree ischemic mitral regurgitation (Grade 3 mitral regurgitation on a scale of 0 to 4) and coronary artery disease, without leaflet pathology, underwent isolated coronary artery bypass surgery. Patients were followed-up at a mean of 22 months and an echocardiographic evaluation was done to determine the progress of the mitral disease. RESULTS: The 30-day operative mortality rate was 2.1%. In the postoperative period, the mean ejection fraction was 46.9% and the mean functional capacity of the patients was 1.31. Mitral regurgitation regressed to a mild degree in 56.9% of the patients. The 2-year survival rate was 93.7%. CONCLUSIONS: Patients with moderate ischemic mitral regurgitation and coronary artery disease who underwent coronary artery bypass surgery alone had acceptable results. We are of the opinion that isolated coronary artery bypass surgery might be a good treatment choice for moderate degree ischemic mitral regurgitation.

Intracoronary shunt reduces postoperative troponin leaks: a prospective randomized study.

OBJECTIVE: The purpose of this study was to evaluate whether intracoronary shunt usage reduced the myocardial damage on the basis of the cardiac markers when compared with the shuntless anastomosis in off-pump coronary artery bypass grafting (OPCABG) surgery of isolated left anterior descending artery lesions. METHODS: Forty patients who had stable angina with isolated left anterior descending (LAD) coronary artery lesion undergoing OPCABG surgery were randomized into two groups. Shunt group consisted of 20 patients who had OPCABG using intracoronary shunt, whereas the shuntless group consisted of 20 patients who underwent OPCABG without using intracoronary shunt. Cardiac troponin I, CK, and CK-MB before and 24h after the surgery were assessed in the groups. RESULTS: There were no deaths in the study. The two groups were similar with respect to sex and age. Duration of LIMA-LAD anastomosis was significantly higher in the shunt group (p=0.01). There was no significant difference between the groups concerning the preoperative and postoperative CK and CK-MB levels. The preoperative troponin I levels of the groups were not different (p=0.238; NS), whereas postoperative levels of this marker was significantly higher in the shuntless group (p=0.003). CONCLUSION: Intracoronary shunt reduced the postoperative troponin I levels significantly, so it may be indicated in the patients who are thought to be susceptible to transient ischemia.