Cardiac positioning using an apical suction device maintains beating heart hemodynamics

Area of Science:

• Cardiovascular Surgery
• Surgical Devices
• Hemodynamics

Background:

• Cardiac positioning is crucial in off-pump coronary artery bypass (OPCAB).
• Deep pericardial sutures (DPS) are commonly used but can lead to hemodynamic compromise.
• Alternative methods for cardiac positioning are needed to improve patient outcomes.

Purpose of the Study:

• To compare the hemodynamic effects of an apical suction device versus deep pericardial sutures (DPS) for cardiac positioning during OPCAB.
• To evaluate the efficacy of an apical suction device in maintaining hemodynamic stability.

Main Methods:

• A study was conducted on five healthy pigs undergoing sternotomy.
• Hemodynamic parameters including right atrial pressure, left ventricular pressure and volume, and aortic pressure and flow were measured.
• Measurements were taken at baseline, with the apical suction device, and during cardiac positioning using both DPS and the apical suction device.

Main Results:

• Deep pericardial sutures (DPS) significantly compromised hemodynamics, reducing cardiac output by up to 30% and mean arterial pressure by up to 26%.
• DPS also led to decreased left ventricular end-diastolic pressure and increased right atrial pressure.
• The apical suction device demonstrated minimal hemodynamic compromise, with only a modest decrease in cardiac output and right atrial pressure during exposure.

Conclusions:

• Deep pericardial sutures (DPS) significantly impair hemodynamics due to reduced left ventricular filling.
• The apical suction device provides adequate cardiac exposure with significantly less hemodynamic compromise compared to DPS.
• An apical suction device represents a hemodynamically superior alternative for cardiac positioning in OPCAB procedures.