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A haemodynamic study during OPCAB surgery using a new multi-suction cardiac positioner
J-M Abicht1, A Bauer, F Christ
1Department of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany. jabicht@med.uni-muenchen.de
Insights
A new heart positioning device (Tentacles) facilitated excellent surgical access for multivessel off-pump coronary artery bypass (OPCAB) grafting. While haemodynamic stability was maintained, additional catecholamine support was required during heart displacement.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Surgical Techniques
Background:
- Multivessel off-pump coronary artery bypass (OPCAB) grafting requires heart displacement for target vessel exposure.
- Maintaining haemodynamic stability during OPCAB is a significant surgical challenge.
- A novel heart positioner, Tentacles, was evaluated for its efficacy and haemodynamic impact.
Purpose of the Study:
- To assess the effectiveness of the Tentacles device in providing surgical access during multivessel OPCAB.
- To investigate the haemodynamic effects of using the Tentacles device for heart displacement.
- To monitor for myocardial ischaemia during the procedure.
Main Methods:
- A prospective clinical study involving 50 patients undergoing multivessel OPCAB.
- Utilized the Tentacles device for heart positioning.
- Monitored haemodynamic parameters: mean arterial blood pressure (MAP), cardiac index (CI), and stroke volume index (SVI).
- Assessed myocardial ischaemia using transoesophageal echocardiography (TEE) and ECG ST-segment analysis.
Main Results:
- The Tentacles device enabled rapid and secure exposure of all cardiac walls.
- Minor decreases in MAP and increases in CI were observed during anterior wall exposure.
- Stroke volume index (SVI) decreased significantly when exposing the lateral and posterior walls.
- Increased norepinephrine administration was noted during heart displacement, while sinus rhythm and ischaemia markers remained stable.
- Postoperative troponin I levels were within expected ranges.
Conclusions:
- The Tentacles device offers excellent surgical access for multivessel OPCAB procedures.
- Haemodynamic stability was generally maintained, though catecholamine support was necessary during heart displacement.
- The device is a viable option for improving surgical exposure in OPCAB surgery.
Background:
Displacement of the heart is necessary to expose the target vessel for distal anastomosis to achieve successful multivessel off-pump coronary artery bypass (OPCAB) grafting. In addition to complete revascularisation of the heart, a main challenge during the operation is to maintain haemodynamic stability during this procedure. A new heart positioner (Tentacles) was tested.
Methods:
In a prospective clinical study we used the Tentacles device in 50 patients scheduled for multivessel OPCAB procedures and investigated the haemodynamic effects during displacement of the heart and while performing the anastomoses to the anterior, lateral and posterior wall. The following haemodynamic parameters were investigated: mean arterial blood pressure (MAP), cardiac index (CI) and stroke volume index (SVI). The incidence of myocardial ischaemia was monitored by transoesophageal echocardiography (TEE) and by ST-segment analysis in the electrocardiogram (ECG).
Result:
The Tentacles device permitted rapid, secure and excellent exposure of the lateral and posterior wall of the heart. During exposure of the anterior wall there was a small decrease in MAP (77 ± 10 vs.71 ± 9 mmHg, P = 0.02) in combination with an increase in the CI (3.0 ± 0.7 l vs. 3.1 ± 0.8 l/min/m2, P = 0.03). When the lateral and posterior walls of the heart were exposed, the SVI decreased significantly (36 ± 11 and 38 ± 8 mL/m2, P < 0.01 and P = 0.04, respectively) compared to baseline (44 ± 11 mL/m2) while CI and MAP remained stable. The amount of norepinephrine administered during displacement of the heart was significantly higher in all three positions (0.05 ± 0.05, 0.06 ± 0.05 and 0.04 ± 0.03 µg/kg/min, P < 0.01) compared to the physiological position (0.02 ± 0.02 µg/kg/min). Sinus rhythm was maintained throughout the operation. Neither significant changes of the ST-segment in the ECG nor incidences of wall motion abnormality in TEE were observed. Six hours postoperatively the troponin I concentration was 11.7 ± 4.3 ng/mL.
Conclusion:
The Tentacles device provided excellent access in multivessel OPCAB surgery. Haemodynamic stability was maintained in all patients; however additional catecholamine support was used when the heart was displaced. This was the case when carrying out an anastomosis on the anterior, lateral, or posterior wall.
