Quantification of Mechanical Stabilization for the Performance of Off-Pump Coronary Artery Surgery

Authors

  • Mark L. Koransky
  • M. Lance Tavana
  • Atsushi Yamaguchi
  • Murray H. Kown
  • Douglas N. Miniati
  • William Nowlin
  • Robert C. Robbins

DOI:

https://doi.org/10.1532/hsf.934

Abstract

Introduction: Our objective was to analyze the motion of a coronary artery in 3-dimensional (3-D) space and to quantify the stabilization afforded by a mechanical arm using 3-D digital sonomicrometry.

Methods: The left anterior descending coronary artery (LAD) was exposed in swine (n = 7) via sternotomy. A 2-mm sonomicrometry crystal was sutured to the LAD, and an acrylic (Plexiglas) ring with 3 2-mm crystals fixed in an equilateral triangle was placed in the oblique pericardial sinus. Sonomicrometry measurements were obtained before and 10 minutes after placement of a stabilizing arm. Traces were analyzed for motion and velocity on a beat-to-beat basis in the x, y, and z planes by means of triangulation theory. Excursion was defined as the average maximum observed distance between LAD Cartesian positions p(k) = [px(k),py(k),pz(k)] over a beat such that the Excursion = max(j,k in beat) sqrt {[px(j) - px(k)]2 + [py(j) - py(k)]2 + [pz(j) - pz(k)]2}. The maximum and the average of the Cartesian velocity magnitude, v = sqrt[vx(2) + vy(2) + vz(2)], were also calculated.

Results: Analysis of the LAD motion in planar space demonstrated a biphasic pattern in all 3 planes that appeared to be stable through the duration of the data acquisition period. The stabilizer dampened the motion of the LAD to a monophasic pattern and reduced the total distance traveled by the LAD crystal in all 3 planes. Stabilization resulted in a significant reduction of excursion, the maximum Cartesian velocity, and the average Cartesian velocity of the LAD.

Conclusions: This method allows the precise quantification of LAD artery motion in 3-D space before and after the application of a stabilizing arm. We have demonstrated a significant reduction in the complexity of motion, the degree of motion in planar space, and the velocity of the LAD after application of a stabilizer. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA

References

Boonstra PW, Grandjean JG, Mariani MA. 1997. Local immobilization of the left anterior descending artery for minimally invasive coronary bypass grafting. Ann Thorac Surg 63(suppl):S76-8.nBorst C, Jansen EW, Tulleken CA, et al. 1996. Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device ("Octopus"). J Am Coll Cardiol 27:1356-64.nBowles BJ, Lee JD, Dang CR, et al. 2001. Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. Chest 119:25-30.nBurfeind WR Jr, Duhaylongsod FG, Samuelson D, Leone BJ. 1998. The effects of mechanical cardiac stabilization on left ventricular performance. Eur J Cardiothorac Surg 14:285-9.n[DHHS] Department of Health and Human Services. 1985. Guide for the care and use of laboratory animals. Bethesda, Md: National Institutes of Health. Publication 86-23.nDiegeler A, Falk V, Matin M, et al. 1998. Minimally invasive coronary artery bypass grafting: experience with the CTS system approach. Perfusion 13:237-42.nJansen EW, Grundeman PF, Borst C, et al. 1997. Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method. Eur J Cardiothorac Surg 12:406-12.nJansen EW, Grundeman PF, Mansvelt Beck HJ, Heijman RH, Borst C. 1997. Experimental off-pump grafting of a circumflex branch via sternotomy using a suction device. Ann Thorac Surg 63(suppl):S93-6.nJansen EW, Lahpor JR, Borst C, Grundeman PF, Bredee JJ. 1998. Off-pump coronary bypass grafting: how to use the Octopus Tissue Stabilizer. Ann Thorac Surg 66:576-9.nKolessov VI. 1967. Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris. J Thorac Cardiovasc Surg 54:535-44.nMack MJ, Acuff T, Osborne J. 1998. Minimally invasive direct coronary artery bypass: technical considerations and instrumentation. J Card Surg 13:290-6.nMohr FW, Falk V, Diegeler A, et al. 2001. Computer-enhanced "robotic" cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg 121:842-53.nNierich AP, Diephuis J, Jansen EW, Borst C, Knape JT 2000. Heart displacement during off-pump CABG: how well is it tolerated? Ann Thorac Surg 70:466-72.nOmeroglu SN, Kirali K, Guler M, et al. 2000. Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 70:844-9.nPuskas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71:1477-84.nSpooner 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.nDiegeler A, Matin M, Kayser S, et al. 1999. Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach. Eur J Cardiothorac Surg 15:680-4.nFalk V, Diegeler A, Walther T, et al. 1999. Endoscopic coronary artery bypass grafting on the beating heart using a computer enhanced telemanipulation system. Heart Surg Forum 2:199-205.nGrundeman PF, Borst C, van Herwaarden JA, Mansvelt Beck HJ, Jansen EW. 1997. Hemodynamic changes during displacement of the beating heart by the Utrecht Octopus method. Ann Thorac Surg 63(suppl):S88-92.nGrundeman PF, Borst C, van Herwaarden, JA, Verlaan CW, Jansen EW. 1998. Vertical displacement of the beating heart by the Octopus tissue stabilizer: influence on coronary flow. Ann Thorac Surg 65:1348-52.nGrundeman PF, Borst C, Verlaan CW, Meijburg H, Moues CM, Jansen EW. 1999. Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass. J Thorac Cardiovasc Surg 118:316-23.nGrundeman PF 1998. Vertical displacement of the beating heart by the Utrecht Octopus tissue stabilizer: effects on haemodynamics and coronary flow. Perfusion 13:229-30.nHolubkov R, Zenati M, Akin JJ, Erb L, Courcoulas A. 1998. MIDCAB characteristics and results: the CardioThoracic Systems (CTS) registry. Eur J Cardiothorac Surg 14(suppl 1):S25-30.nAkpinar B, Guden M, Sagbas E, Sanisoglu I, Aytekin V, Bayindir O. 2000. Off-pump coronary artery bypass grafting with use of the Octopus 2 stabilization system. Heart Surg Forum 3:282-6.nAmano A, Hirose H, Takahashi A, Nagano N. 2001. Off-pump coronary artery bypass: mid-term results. Jpn J Thorac Cardiovasc Surg 49:67-78.n

Published

2005-02-07

How to Cite

Koransky, M. L., Tavana, M. L., Yamaguchi, A., Kown, M. H., Miniati, D. N., Nowlin, W., & Robbins, R. C. (2005). Quantification of Mechanical Stabilization for the Performance of Off-Pump Coronary Artery Surgery. The Heart Surgery Forum, 6(4), 224-231. https://doi.org/10.1532/hsf.934

Issue

Section

Articles

Most read articles by the same author(s)