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Myocardial oxidative stress protection with sevoflurane versus propofol

Tandon, Manish; Pandey, Chandra K.

European Journal of Anaesthesiology: June 2012 - Volume 29 - Issue 6 - p 296–297
doi: 10.1097/EJA.0b013e328351660a

From the Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India

Correspondence to Dr Manish Tandon, MD, Assistant Professor, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi 110070, India E-mail:

Published online 22 February 2012


We read with great interest the scientific report by Ballester et al.1 We appreciate the conclusion they have drawn. However, we have several concerns. We would like to know whether coronary sinus injury occurred in their patients. The authors mention that the coronary sinus was catheterised and the catheter remained in situ while the distal coronary anastomoses were performed. Beating heart coronary artery bypass graft surgery involves manipulation of the heart, at times to extreme degrees. Leaving a coronary sinus catheter in situ could damage the coronary sinus. Coronary sinus injury can be difficult to repair and may result in death.2,3 It must have been difficult to manage the correct positioning of the coronary sinus catheter in a beating heart, as it would have repeatedly dislodged either into right atrium (RA) or further into the coronary sinus despite being anchored to the RA wall, thus hampering the venous drainage of the heart.

Another concern that we wish to share is that a coronary shunt was not used for the conduct of the anastomosis. We appreciate that this must have been a surgical decision, but in a patient with coronary artery stenosis undergoing beating heart surgery, the degree of metabolic demand and supply mismatch is much higher than in a pleaged heart. A vascular shunt not only aids in conduct of the anastomosis but also ensures the available flow to the distal myocardial tissue in the affected territory.4,5 The authors did not mention if any other means of distal coronary perfusion was used in their patients. Complications observed in absence of distal coronary perfusion should also be described.

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1. Ballester M, Llorens J, Garcia-de-la-Asuncion J, et al. Myocardial oxidative stress protection by sevoflurane vs. propofol: a randomised controlled study in patients undergoing off-pump coronary artery bypass graft surgery. Eur J Anaesthesiol 2011; 28:874–881.
2. Langenberg CJM, Pietersen HG, Geskes G, et al. Coronary sinus catheter placement: assessment of placement criteria and cardiac complications. Chest 2003; 124:1259–1265.
3. Economopoulos GC, Michalis A, Palatianos GM, Sarris GE. Management of catheter-related injuries to the coronary sinus. Ann Thorac Surg 2003; 76:112–116.
4. Gandra SM, Rivetti LA. Experimental evidence of regional myocardial ischemia during beating heart coronary bypass: prevention with temporary intraluminal shunts. Heart Surg Forum 2002; 6:10–18.
5. Lucchetti V, Capasso F, Caputo M, et al. Intracoronary shunt prevents left ventricular function impairment during beating heart coronary revascularization. Eur J Cardiothorac Surg 1999; 15:255–259.
© 2012 European Society of Anaesthesiology