title: Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method.
abstract: OBJECTIVE
  Target site immobilization is essential to enable meticulous anastomosis suturing during coronary artery bypass grafting on the beating heart. A novel device ('Octopus') was developed for local heart muscle immobilization by suction. The purpose of this study was to investigate the efficacy of the method through a limited access.
  
  
  METHODS
  The suction device, placed on either side of the recipient coronary artery and fixed to the operating table-rail through an arm construction, restrains anastomosis site motion to 1 x 1 mm. A total of 27 patients underwent off-pump arterial bypass grafting using this method. Preoperatively, all patients had angina class III (NYHA) and were failed or unsuitable candidates for balloon angioplasty. Surgical access was via a 10-cm anterior thoracotomy (n = 26) or 10-cm subxiphoid incision (n = 1).
  
  
  RESULTS
  Harvesting of the graft required 48 +/- 12 min (mean +/- S.D.). Immobilization with the 'Octopus' was effective and facilitated precise anastomosis suturing of 20 single and 7 sequential grafts. Immobilization did not change cardiac index and mean arterial blood pressure. During coronary surgery, however, inotropic drug support was used in 5 of 27 (18%) of patients. There was no myocardial infarction. Only minor transient complications were met. There were electro-cardiographical signs of pericarditis in 6 patients. The postoperative hospital stay ranged from 2 to 6 days, mean 4.0 +/- 1.2 days. The mean follow-up is 6.5 +/- 4 months (range, 1-12 months). All patients except one were in functional class I without angina. Social activities were resumed within 4 weeks. At 6 months angiography was performed in 15 out of 27 patients. The patency rate of 19 out of 20 anastomoses was 95%. All distal grafts were patent. One side to side anastomosis was occluded.
  
  
  CONCLUSIONS
  The 'Octopus' immobilization method is safe and effective. It facilitates less invasive CABG in selected patients and gives way to fast recovery by reducing invasiveness.
authors.affiliation: Division of Cardiothoracic Surgery, Heart-lung Institute, University Hospital, Utrecht, Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Jansen
authors.forename: P F
authors.initials: PF
authors.lastname: Gründeman
authors.forename: C
authors.initials: C
authors.lastname: Borst
authors.forename: F
authors.initials: F
authors.lastname: Eefting
authors.forename: J
authors.initials: J
authors.lastname: Diephuis
authors.forename: A
authors.initials: A
authors.lastname: Nierich
authors.forename: J R
authors.initials: JR
authors.lastname: Lahpor
authors.forename: J J
authors.initials: JJ
authors.lastname: Bredée
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D013396:Suction / Q000295:instrumentation*; D013895:Thoracic Arteries / Q000637:transplantation; D013908:Thoracotomy / Q000379:methods*; D014463:Ultrasonography