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Hemodynamic effects of elevation and stabilization of the heart during off-pump coronary surgery
G D'Ancona1, H Karamanoukian, R Lima
1The Center for Less Invasive Coronary Surgery, Kaleida Health System, and Department of Cardiothoracic Surgery, State University of New York at Buffalo, USA.
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is feasible. A novel single-suture technique safely exposes coronary arteries for complete revascularization, maintaining stable hemodynamics.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Surgical Techniques
Background:
- Coronary artery bypass grafting (CABG) is increasingly performed off-pump (without cardiopulmonary bypass).
- Achieving complete myocardial revascularization requires effective exposure of target coronary arteries while maintaining hemodynamic stability.
- A novel surgical approach has been developed to facilitate off-pump CABG.
Purpose of the Study:
- To evaluate the safety and efficacy of a new "single-suture" technique for exposing coronary arteries during off-pump CABG.
- To assess hemodynamic changes during the "single-suture" technique and complete myocardial revascularization.
- To determine the feasibility of achieving complete revascularization without cardiopulmonary bypass.
Main Methods:
- Complete myocardial revascularization was performed in 18 consecutive patients using the "single-suture" technique.
- The technique involves pericardial suturing to elevate and rotate the heart, exposing target coronary arteries.
- Hemodynamic parameters, including cardiac index (CI) and intracardiac pressures, were monitored using a Swan-Ganz catheter.
Main Results:
- All 18 patients underwent successful off-pump CABG without complications or mortality.
- No significant hemodynamic alterations were observed during heart elevation or coronary artery snaring.
- A marked increase in pulmonary artery wedge pressure (PAWP) occurred during circumflex artery manipulation (p < 0.05), with improved CI and cardiac output (CO) before chest closure (p < 0.05).
Conclusions:
- Complete myocardial revascularization is safely achievable without cardiopulmonary bypass.
- The "single-suture" technique effectively exposes all target coronary arteries.
- This method allows for off-pump CABG without compromising hemodynamic stability.
Background:
Coronary artery bypass grafting (CABG) surgery is now being performed without the use of cardiopulmonary bypass (CPB). To achieve complete myocardial revascularization off-CPB, a technique has been developed to expose target coronary arteries while hemodynamics are maintained.
Methods:
Complete myocardial revascularization was performed in 18 consecutive patients. Exposure of target coronary arteries was achieved by a "single-suture" technique, placed in the oblique sinus of the pericardium. Traction on the suture elevates and rotates the heart, thereby exposing all target coronary arteries. Cardiac index (CI) and intracardiac pressures were measured with a Swan-Ganz catheter during the different phases of the operation.
Results:
All patients were successfully operated on without CPB. There were no postoperative complications or deaths. There were no major hemodynamic changes during the different stages of the operation; in other words, CI was unchanged during elevation of the heart and snaring of the main coronary branches. Pulmonary artery wedge pressure (PAWP) increased markedly during occlusion and stabilization of the circumflex coronary artery (p < 0.05). A marked increase in CI and cardiac output (CO) from baseline values was also recorded before chest closure (p < 0.05).
Conclusion:
Complete myocardial revascularization can be achieved safely without CPB. The single-suture technique allows for exposure of all target coronary arteries without hemodynamic compromise.