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Right heart circulatory support facilities coronary artery bypass without cardiopulmonary bypass
M Mathison1, E Buffolo, A D Jatene
1Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. mnmathison@aol.com
Insights
Right-heart support safely managed hemodynamic instability during beating heart coronary artery bypass (CAB) surgery. This technique enabled successful posterior wall revascularization in all patients without complications.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Medical Devices
Background:
- Posterior wall revascularization during beating heart coronary artery bypass (CAB) can lead to hemodynamic instability.
- Previous studies indicated heart tilting affects right-heart hemodynamics.
- Clinical evaluation of right-heart support was necessary.
Purpose of the Study:
- To evaluate the safety and efficacy of a right-heart support system in clinical cases of beating heart CAB.
- To assess the impact of right-heart support on hemodynamic stability during posterior wall revascularization.
Main Methods:
- Seventeen patients undergoing beating heart CAB received right-heart support.
- A coaxial cannula was placed via the right atrium to the main pulmonary artery.
- Blood was withdrawn from the right atrium and returned to the pulmonary artery.
Main Results:
- Successful elective beating heart CAB was performed in all 17 patients.
- Right-heart support (1-3 L/min) improved hemodynamics, particularly during circumflex artery anastomosis.
- No device-related incidents, infections, or air embolisms occurred; all patients were discharged.
Conclusions:
- The right-heart support system demonstrated safety and efficacy in clinical CAB procedures.
- This support system facilitated posterior wall exposure without causing hemodynamic compromise.
- Right-heart support is a viable option for managing hemodynamics in complex CAB surgeries.
Background:
Revascularization of the posterior wall often causes hemodynamic instability in beating heart coronary artery bypass (CAB). Our previous clinical studies have shown that tilting the heart primarily alters right-heart hemodynamics. The purpose of this study was to evaluate right-heart support in clinical cases.
Methods:
Seventeen patients underwent beating heart CAB with right-heart support. The right-heart support system (A-Med Systems, West Sacramento, CA) consisted of a coaxial cannula placed through the right atrium and the tip of the cannula positioned in main pulmonary artery. Blood was removed from the right atrium and returned to the main pulmonary artery.
Results:
Elective beating heart CAB was accomplished successfully in 17 patients with right-heart support. Anastomoses performed were left anterior descending coronary artery (11), diagonal (3), circumflex (5), obtuse marginal artery (11), and right coronary artery (10). Right-heart support between 1 and 3 L/min improved hemodynamics especially in the circumflex position. No device-related patient incidents occurred, nor were there incidents of infection or air embolism. All 17 patients were discharged to their homes.
Conclusions:
The right-heart support system was safe without complications. Exposure of the posterior wall was possible in all cases without hemodynamic compromise.