Related Experiment Videos
The enabler right ventricular circulatory support system for beating heart coronary artery bypass graft surgery
G G Geskes1, A L Dekker, F H van der Veen
1Department of Cardiothoracic Surgery, University Hospital and Cardiovascular Research Institute, Maastricht, The Netherlands. g.geskes@scpc.azm.nl
Insights
Tilting the heart during coronary artery bypass graft surgery can cause hemodynamic instability. The Enabler right ventricular support system can help counteract these effects, improving stroke volume during the procedure.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Hemodynamics
Background:
- Beating heart coronary artery bypass graft (CABG) surgery is feasible with the Octopus Stabilization System.
- Heart tilting required for accessing certain coronary targets can lead to hemodynamic instability.
- The Enabler right ventricular circulatory support system's potential to mitigate this instability requires investigation.
Purpose of the Study:
- To evaluate the efficacy of the Enabler right ventricular support system in managing hemodynamic instability during heart tilting in CABG surgery.
- To assess the impact of Enabler support on cardiac function during surgical maneuvers requiring ventricular displacement.
Main Methods:
- The study involved 8 sheep undergoing simulated CABG procedures.
- The Enabler system was cannulated via the jugular vein, targeting the right atrium and pulmonary artery.
- Hemodynamic parameters, including ventricular Pressure Volume (PV) loops, were recorded during heart tilting with and without Enabler support.
Main Results:
- Heart tilting significantly reduced stroke volume, by 31% for inferior exposure and 17% for posterior exposure.
- Activation of the Enabler system partially restored stroke volume, increasing it by 13% for inferior and 31% for posterior exposure.
Conclusions:
- Heart tilting during CABG surgery poses significant hemodynamic challenges.
- The Enabler right ventricular support system offers a potential solution to partially mitigate these hemodynamic consequences.
- Enabler support demonstrates a beneficial effect on stroke volume during critical surgical maneuvers.
Background:
Beating heart coronary artery bypass graft surgery of the left anterior descending, diagonal, and right coronary artery can be performed safely with the Octopus Stabilization System. However, tilting of the heart, which is necessary to reach the obtuse marginal and distal right coronary arteries, causes hemodynamic instability. This study was performed to investigate the possible role of the Enabler right ventricular circulatory support system in counteracting this instability.
Methods:
In 8 sheep, the Enabler cannula was introduced via the jugular vein and positioned with the inlet valve in the right atrium and outlet valve in the pulmonary artery. The Octopus was used to expose the inferior wall and the posterior wall of the left ventricle. The hemodynamic effects of this tilting with and without Enabler right ventricular support were recorded, including Pressure Volume (PV) loops measured by conductance catheters in both ventricles.
Results:
Tilting caused a reduction in stroke volume (inferior 31%, posterior 17%) and Enabler activation increased stroke volume (inferior 13%, posterior 31%).
Conclusions:
Tilting the heart has severe hemodynamic consequences that can be partially counteracted by the use of the Enabler for right ventricle support.