Hemodynamic effects of elevation and stabilization of the heart during off-pump coronary surgery.
BACKGROUND
Coronary artery bypass grafting (CABG) surgery is now being performed without the use of cardiopulmonary bypass (CPB). To achieve complete myocardial revascularization off-CPB, a technique has been developed to expose target coronary arteries while hemodynamics are maintained.


METHODS
Complete myocardial revascularization was performed in 18 consecutive patients. Exposure of target coronary arteries was achieved by a "single-suture" technique, placed in the oblique sinus of the pericardium. Traction on the suture elevates and rotates the heart, thereby exposing all target coronary arteries. Cardiac index (CI) and intracardiac pressures were measured with a Swan-Ganz catheter during the different phases of the operation.


RESULTS
All patients were successfully operated on without CPB. There were no postoperative complications or deaths. There were no major hemodynamic changes during the different stages of the operation; in other words, CI was unchanged during elevation of the heart and snaring of the main coronary branches. Pulmonary artery wedge pressure (PAWP) increased markedly during occlusion and stabilization of the circumflex coronary artery (p < 0.05). A marked increase in CI and cardiac output (CO) from baseline values was also recorded before chest closure (p < 0.05).


CONCLUSIONS
Complete myocardial revascularization can be achieved safely without CPB. The single-suture technique allows for exposure of all target coronary arteries without hemodynamic compromise.
D'Ancona
G
G
The Center for Less Invasive Coronary Surgery, Kaleida Health System, and Department of Cardiothoracic Surgery, State University of New York at Buffalo, USA.
Karamanoukian
H
H
Lima
R
R
Ricci
M
M
Bergsland
J
J
Rossman
J
J
Salerno
T
T
D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D013536:Suture Techniques