A Miniature Right Heart Support System Improves Cardiac Output and Stroke Volume during Beating Heart Posterior/Lateral Coronary Artery Bypass Grafting

Authors

  • Dwight C. Lundell
  • John D. Crouch

DOI:

https://doi.org/10.1532/hsf.971

Abstract

Background: Certain heart manipulations carried out to access anastomotic sites during beating heart coronary artery bypass (OPCAB) compromise hemodynamics, and these risks can affect end-organ perfusion and limit patient selection. Evidence suggests that right heart support (RHS) augments left ventricular preload and provides hemodynamic stability. This study evaluated hemodynamic measures in OPCAB with RHS with respect to individual target vessels and general target distribution groups.

Methods: Beating heart surgery was performed on 52 patients with left ventricular preload managed with RHS. The average patient age was 69.9 years, and the average ejection fraction was 42.9% ± 10.9%. Measurements of cardiac output, stroke volume, mean arterial pressure (MAP), heart rate, and cardiac index (CI) were taken at baseline, during each anastomosis with the optimal heart position, and when the RHS was momentarily interrupted prior to heart release. Anastomoses were categorized individually and into posterior/lateral (n = 91) or anterior/right (n = 90) groups and divided into the following output groups based on CI with optimal heart positioning without RHS: group 1 (low output; CI < 1.8), group 2 (marginal output; 1.8 £ CI < 2.2), group 3 (acceptable output; CI ³ 2.2), and group 4 (output unchanged or increased).

Results: One hundred eighty-one vessels were grafted with an average of 3.5 per patient. Significant reductions in CI, MAP, and stroke volume were observed for all target vessels when RHS was briefly off, especially for posterior and lateral target vessels (12%-26% decrease). In both posterior/ lateral and anterior/right target vessel groups, RHS improved CI and MAP in ³ 90% of the anastomoses (groups 1-3). Without RHS, 60% of posterior/lateral and 54% of anterior/ right target positions resulted in critically low or marginal output (groups 1 and 2). There was one bypass conversion and no surgical interruptions, intraoperative intra-aortic balloon pump placements, or deaths. Conclusion: Augmenting left ventricular preload with RHS improves hemodynamic measures during OPCAB for all target vessel positions and provides critical support in a large number of anastomoses.

References

Mathison M, Edgerton JR, Horswell JL, Akin JJ, Mack MJ. 2000. Analysis of hemodynamic changes during beating heart surgical procedures. Ann Thorac Surg 70:1355-60; discussion 1360-1.nMurkin JM. 2002. Hemodynamic changes during cardiac manipulation in off-CPB surgery: relevance in brain perfusion. Heart Surg Forum 5:221-4.nPorat E, Sharony R, Ivry S, et al. 2000. Hemodynamic changes and right heart support during vertical displacement of the beating heart. Ann Thorac Surg 69:1188-91.nSharony R, Autschbach R, Porat E, et al. 2002. Right heart support during off-pump coronary artery bypass surgery: a multi-center study. Heart Surg Forum 5:13-6.nAscione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. 2000. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 69:1198-204.nCaputo M, Yeatman M, Narayan P, et al. 2002. Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial. Ann Thorac Surg 74:2088-96.nde Carvalho Lima R, Escobar M, Lobo Filho JG. 2002. Patient selection in off-cardiopulmonary bypass revascularization. Heart Surg Forum 5:229-33.nDemaria RG, Carrier M, Fortier S, et al. 2002. Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation 106(suppl):I-5-10.nDo QB, Goyer C, Chavanon O, Couture P, Denault A, Cartier R. 2002. Hemodynamic changes during off-pump CABG surgery. Eur J Cardiothorac Surg 21:385-90.nHeames RM, Gill RS, Ohri SK, Hett DA. 2002. Off-pump coronary artery surgery. Anaesthesia 57:676-85.nLima LE, Jatene F, Buffolo E, et al. 2001. A multicenter initial clinical experience with right heart support and beating heart coronary surgery. Heart Surg Forum 4:60-4.nLund O, Christensen J, Holme S, et al. 2001. On-pump versus off-pump coronary artery bypass: independent risk factors and off-pump graft patency. Eur J Cardiothorac Surg 20:901-7.n

Published

2005-02-08

How to Cite

Lundell, D. C., & Crouch, J. D. (2005). A Miniature Right Heart Support System Improves Cardiac Output and Stroke Volume during Beating Heart Posterior/Lateral Coronary Artery Bypass Grafting. The Heart Surgery Forum, 6(5), 302-306. https://doi.org/10.1532/hsf.971

Issue

Section

Articles