Off-Pump Arterial Revascularization Using a New Reusable Device for Coronary Occlusion and Local Stabilization

  • Friedrich-Christian Riess
  • Ralf Bader
  • Bettina Hoffmann
  • Joachim Kormann
  • Joachim Kormann
  • Joachim Kormann
  • Bettina Hoffmann

Abstract

Background: Optimal local stabilization, an unobstructed view, and a free field for operation are of most importance during off-pump surgery to facilitate high-quality anastomoses. We report on a new reusable stabilizing platform for complete off-pump coronary revascularization.

Methods: From May 2001 until June 2002, 118 consecutive patients (82 men, 36 women) with coronary artery disease (61 with 1-vessel, 42 with 2-vessel, and 15 with 3-vessel disease) and a mean age of 63.6 ± 10.0 years (range, 41-88 years) were scheduled for complete off-pump arterial revascularization. The mean left ventricular ejection fraction was 56.5% ± 12.5% (range, 25%-85%). Exposure of the coronary vessels was facilitated with deep pericardial slings. The target coronary vessel was snared twice with air-cushioned silicone loops and fixed to the platform, which was connected to a flexible steel arm. The platform is available in 3 versions with different connector angles to accommodate various anatomical conditions. Together with its flat design, the platform provides an unobstructed view and a free field of operation.

Results: All operations were performed without any intraoperative complications, and all planned bypasses were carried out. The mean number of bypass grafts was 1.7 ± 0.8 (range, 1-5). There was no early (30 days) mortality. The postoperative course was uneventful in all patients except for 1 reexploration for retrosternal bleeding, 10 patients with temporary atrial fibrillation, and 1 patient with reintubation after early extubation in the operating room because of respiratory insufficiency. Patients were discharged from the hospital in good condition 8.7 ± 2.6 days (range, 5-18 days) after surgery. Conclusions: Our data indicate that complete arterial off-pump revascularization can be performed safely and effectively

References

Spooner TH, Hart JC, Pym J. 1999. A two-year, three institution experience with the Medtronic Octopus: systematic off-pump surgery. Ann Thorac Surg 68:1478-81.\nPlace DG, Peragallo RA, Carrol J, Cusimano RJ, Cheng DCH. 2002. Postoperative atrial fibrillation: a comparison of off-pump coronary artery bypass surgery and conventional coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 16:144-8.\nRicci M, Karamanoukian HL, Dancona G, Bergsland J, Salerno TA. 2001. On-pump and off-pump coronary artery bypass grafting in elderly: predictors of adverse outcome. J Card Surg 16:458-66.\nRiess FC, Bader R, Kremer P, et al. 2002. Coronary hybrid revascularization from January 1997 to 2001: a clinical follow-up. Ann Thorac Surg 73:1849-55.\nRiess FC, Bleese N, Riess AG. 1999. A new method for coronary occlusion and local stabilization during minimally invasive LIMA-to-LAD bypass. Eur J Cardiothorac Surg 15:206-8.\nRiess FC, Moshar S, Bader R, et al. 2000. Clinical outcome ofpatients with and without renal impairment undergoing a minimally invasive LIMA-to-LAD bypass operation. Heart Surg Forum 3:313-8.\nRoy A, Stanbridge RL, O'Regan D, et al. 2001. Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. Heart SurgForum 4:174-8.\nAnderson DR, Edmunds LH, Stephenson LW. 1991. Management of complications of cardiopulmonary bypass: complications of organ systems. In: Waldhausen JA, Orringer MB, eds. Complications in cardiothoracic surgery. St. Louis, Mo: Mosby Year Book. p 45-59.\nAscione R, Williams S, Lloyd CT, Sundaramoorthi T, Pitsis AA, Angelini GD. 2001. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.\nChertow GM, Levy EM, Hammermeister KE, et al. 1998. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104:343-8.\nCohn WE, Sirios CA, Johnson RG. 1999. Atrial fibrillation after minimally invasive coronary artery bypass grafting surgery: a retrospective matched study. J Thorac Cardiovasc Surg 117:298-301.\nDiegeler A, Matin M, Kayser S, et al. 1999. Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary grafting (MIDCAB) approach. Eur J Cardiothorac Surg 15:680-4.\nDoty JR, Fonger JD, Nicholson CF, et al. 1997. Cost analysis of current therapies for limited coronary artery revascularization. Circulation 96: II-16-20.\nHart JC, Spooner TH, Pym J, et al. 2000. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg 70:1017-20.\nIzzat MB, Yim AP, El-Zufari MH. 1998. Minimally left anterior descending coronary artery revascularization in high-risk patients with three-vessel disease. Ann Thorac Cardiovasc Surg 4:205-8.\nKappert U, Gulielmos V, Knaut M, et al. 1999. The application of the Octopus stabilizing system for the treatment of high risk patients with coronary artery disease. Eur J Cardiothorac Surg 16(suppl 2):57-9.\nLoef BG, Epema AH, Navis G, Ebels T, van Oeveren W, Henning RH. 2002. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest 121:1190-4.\nMeharwal ZS, Trehan N. 2002. Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. Heart Surg Forum 5:41-5.\nPatel NC, Pullan DM, Fabri BM. 2002. Does off-pump total arterial revascularization without aortic manipulation influence neurological outcome? A study of 226 consecutive, unselected cases. Heart Surg Forum 5:28-32.\n
Published
2005-01-04
How to Cite
Riess, F.-C., Bader, R., Hoffmann, B., Kormann, J., Kormann, J., Kormann, J., & Hoffmann, B. (2005). Off-Pump Arterial Revascularization Using a New Reusable Device for Coronary Occlusion and Local Stabilization. The Heart Surgery Forum, 7(1), E107-E112. https://doi.org/10.1532/hsf.1000
Section
Articles