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Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one
E W Jansen1, C Borst, J R Lahpor
1Heart-Lung Institute, Department of Cardiopulmonary Surgery, Utrecht University Hospital, The Netherlands.
Insights
Off-pump coronary artery bypass grafting using the Octopus tissue stabilizer is safe and effective. This method shows promising results for graft patency and patient recovery, warranting further comparison with traditional bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Surgical Stabilization Technologies
Background:
- Conventional coronary artery bypass grafting (CABG) utilizes cardiopulmonary bypass, which carries inherent adverse effects.
- Off-pump CABG reduces invasiveness but poses challenges in suturing due to cardiac motion.
- Effective local cardiac wall stabilization is crucial for successful off-pump CABG.
Purpose of the Study:
- To prospectively assess the safety and efficacy of the Octopus tissue stabilizer for off-pump coronary artery bypass grafting.
- To evaluate the performance of the Octopus tissue stabilizer in immobilizing the anastomosis site.
- To determine the clinical outcomes and graft patency rates in patients undergoing off-pump CABG with this device.
Main Methods:
- Prospective assessment of the Octopus tissue stabilizer in 100 patients undergoing off-pump CABG.
- Utilized two suction paddles (-400 mm Hg) attached to an articulating arm for local cardiac wall stabilization.
- Patients were selected for full or limited surgical access.
Main Results:
- 141 grafts (96% arterial) and 172 anastomoses were created.
- Low complication rates: 2% conversion to cardiopulmonary bypass, 4% myocardial infarction, 2% predischarge reintervention.
- 95% anastomosis patency at 6-month angiographic follow-up.
- 98% of patients were in Canadian Cardiovascular Society class I at mean 13-month follow-up.
Conclusions:
- Off-pump coronary artery bypass grafting with the Octopus tissue stabilizer is a safe procedure.
- The device facilitates effective local cardiac stabilization, improving anastomosis outcomes.
- Promising early clinical outcomes and graft patency support further randomized trials against conventional CABG.
Objective:
Cardiopulmonary bypass and global cardiac arrest enable safe coronary artery bypass grafting but have adverse effects. In off-pump coronary bypass grafting, invasiveness is reduced, but anastomosis suturing is jeopardized by cardiac motion. Therefore the key to successful off-pump coronary bypass grafting is effective local cardiac wall stabilization.
Methods:
We prospectively assessed the safety and efficacy of the Octopus tissue stabilizer (Medtronic, Inc., Minneapolis, Minn.) in the first 100 patients selected for off-pump coronary bypass via full or limited surgical access. To immobilize and expose the coronary artery, two suction paddles (-400 mm Hg), fixed to the operating table-rail by an articulating arm, stabilized the anastomosis site.
Results:
One hundred forty-one grafts (96% arterial) were used to create 172 anastomoses (17% side-to-side), up to 4 per patient, on average 23 in the full access group (46 patients) and 1.2 in the limited access group (54 patients). Complications included conversion to cardiopulmonary bypass (2%), conversion from limited to full access (3%), myocardial infarction (4%), predischarge coronary reintervention (2%), and late coronary reintervention (1%). Median postoperative length of hospital stay was 4 days (limited access) or 5 days (full access). Rapid recovery allowed 96% of patients to resume social activities within 1 month. At the 6-month angiographic follow-up, 95% of anastomoses was patent. At the 2- to 22-month follow-up (mean, 13 months), 98 patients were in Canadian Cardiovascular Society class I and 2 patients were in class II.
Conclusion:
These results suggest that off-pump coronary artery bypass grafting with the Octopus tissue stabilizer is safe. Early clinical outcome and patency rates warrant a randomized study comparing this methods with conventional coronary bypass grafting.