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Coronary artery bypass grafting using a miniature right ventricular support system
1A-Med Systems Inc, West Sacramento, California, USA. jtgoblue@alumni.umich.edu
Insights
A novel miniature extracorporeal system offers right ventricular support for beating heart surgery. This system enables epicardial procedures without cardiopulmonary bypass, potentially improving cardiac output during complex coronary artery disease interventions.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Cardiology
Background:
- Cardiopulmonary bypass (CPB) with cardioplegic myocardial preservation is the standard for coronary artery disease surgery.
- Current beating heart surgical techniques using epicardial stabilizing devices are limited to anterior vessels due to manipulation-induced hemodynamic compromise.
Purpose of the Study:
- To introduce a novel miniature extracorporeal system designed for beating heart surgery.
- To evaluate the system's potential for maintaining cardiac output during epicardial procedures without standard CPB.
Main Methods:
- Development of a miniature extracorporeal system with a coaxial atrial cannula and a miniature centrifugal pump.
- The system drains blood from the right atrium, pumps it, and reinfuses it into the pulmonary artery.
- The circuit has a low volume (approx. 30 ml) and is controlled externally.
Main Results:
- The system provides right ventricular support, facilitating epicardial surgical procedures on a beating heart.
- It allows for coronary anastomoses without the need for conventional cardiopulmonary bypass.
- The centrifugal pump delivers blood flow at rates of 1-6 L/min.
Conclusions:
- This miniature extracorporeal system represents a potential advancement for beating heart surgery.
- It may overcome limitations of current techniques by enabling revascularization of posterior and lateral vessels.
- The system could be beneficial in maintaining adequate cardiac output during complex epicardial interventions.
Abstract:
Cardiopulmonary bypass (CPB) with cardioplegic myocardial preservation has long been the gold standard for surgical care of coronary artery disease. More recently, alternatives to the conventional approach of CPB-myocardial revascularization have been developed. Epicardial stabilizing devices have been used to immobilize areas of the beating heart to provide a stable surface for some coronary anastomoses. These approaches are often limited to anterior aspects of the heart because revascularization of posterior and lateral vessels often requires the heart to be manipulated or contorted. Excessive manipulation can lead to hemodynamic compromise as a result of partially obstructing pulmonary blood flow. A miniature extracorporeal system has been developed that uses right ventricular support and allows for epicardial surgical procedures to be conducted on a beating heart without standard CPB. The extracorporeal system consists of a coaxial atrial cannula that is connected to a miniature centrifugal pump. Blood is drained from the right atrium, passes through the miniature centrifugal pump and is delivered through the cannula's inner reinfusion lumen into the pulmonary artery. The entire circuit volume is approximately 30 ml. The system is positioned on the sterile operative field. The pump is controlled by a console positioned adjacent to the patient. The centrifugal pump is capable of delivering blood flow at rates of 1-6 l/min. This extracorporeal system may be of benefit in maintaining adequate cardiac output during epicardial beating heart surgery.