Cardiac Positioning using an Apical Suction Device Maintains Beating Heart Hemodynamics

Authors

  • Jerome Sepic Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Jon O. Wee Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Edward G. Soltesz Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Michael K. Hsin Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Lawrence H. Cohn Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Rita G. Laurence Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  • Lishan Aklog Division of Cardiac Surgery , Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Abstract

Background: Cardiac positioning during off-pump coronary artery bypass (OPCAB) using deep pericardial sutures
(DPS) typically results in some degree of hemodynamic compromise. We sought to determine whether cardiac positioning
using an apical suction device was hemodynamically superior to DPS.
Methods: Five healthy pigs underwent sternotomy and instrumentation to measure right atrial (RA) pressure, left ventricular (LV) pressure and volume, and aortic pressure and flow. These variables were recorded at baseline, with simple attachment of the apical suction device (XposeTM Access Device, Guidant, Inc.), and during exposure of the posterior descending artery (PDA) and obtuse marginal (OM) branches of the left circumflex artery using DPS and the apical suction device.
Results: Application of the apical suction device to the beating heart in neutral anatomic position did not result in any statistically significant change in hemodynamics compared to baseline except for a small decrease in RA pressure. DPS positioning resulted in statistically significant compromise in nearly all measured hemodynamic parameters, including cardiac output (-21% PDA, -30% OM), mean arterial pressure (-18% PDA, -26% OM), and stroke work (-31% PDA, -38% OM). In addition, LV end-diastolic pressure decreased (-59% PDA, -51% OM) while RA pressure increased (+17% PDA, +16% OM). Similar target exposure using the apical suction device resulted in near-baseline hemodynamics. The only statistically significant changes were a modest decrease in cardiac output (-18% OM) and RA pressure (-11% PDA).
Conclusion: DPS positioning significantly compromises hemodynamics due to reduced LVfilling. The apical suction device provides good exposure with less hemodynamic compromise.

Published

2002-09-01

How to Cite

Sepic, J., Wee, J. O., Soltesz, E. G., Hsin, M. K., Cohn, L. H., Laurence, R. G., & Aklog, L. (2002). Cardiac Positioning using an Apical Suction Device Maintains Beating Heart Hemodynamics. The Heart Surgery Forum, 5(3), E279-E284. Retrieved from https://journal.hsforum.com/index.php/HSF/article/view/6139

Issue

Vol. 5 No. 3 (2002)

Section

Article
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