A novel perfusion catheter for hybrid procedures in minimally invasive bypass surgery.
BACKGROUND
Combined off-pump bypass grafting and percutaneous coronary intervention (hybrid procedures) is supposed to be beneficial for high-risk patients. We developed a novel perfusion catheter to facilitate these hybrid interventions.


METHODS
First, we tested coagulatory activation in vitro. Afterwards, 6 landrace pigs underwent active coronary perfusion of the LAD. In a second study, 15 pigs underwent off-pump bypass surgery (LIMA to LAD grafting) and the catheter was used to provide myocardial perfusion and prevent bleeding at the site of the coronary anastomosis.


RESULTS
In the in vitro perfusion studies, no activation of coagulation or clotting occurred. Active coronary perfusion was feasible without signs of regional myocardial ischemia or coagulation over a 50-minute period. During off-pump bypass surgery, the catheter prevented bleeding in the operation field and facilitated the surgical procedure.


CONCLUSIONS
The new perfusion catheter can optimize the conditions of off-pump bypass surgery by preventing bleeding in the operation field, maintaining myocardial perfusion and allowing direct angiographic control of the anastomosis. Therefore, this new technique could be an important tool to facilitate hybrid interventions.
Strotmann
J M
JM
Medizinische Klinik, Klinikum Mannheim, University of Heidelberg, Germany. J.Strotmann@gmx.net
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Hagl
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Babin-Ebell
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Voelker
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D000714:Anastomosis, Surgical / Q000295:instrumentation; D000818:Animals; D016063:Blood Loss, Surgical; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002404:Catheterization / Q000295:instrumentation*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D003331:Coronary Vessels / Q000601:surgery; D005240:Feasibility Studies; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D066298:In Vitro Techniques; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000601:surgery; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D023421:Models, Animal; D010477:Perfusion / Q000295:instrumentation*; D013536:Suture Techniques / Q000295:instrumentation; D013552:Swine