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J Thorac Cardiovasc Surg 1998;116:60-67
© 1998 Mosby, Inc.
Surgery For Adult Cardiovascular Disease |
The study was supported by a grant from The Netherlands Heart Foundation (No. 1993/43.028) and the University Hospital, Utrecht (No. 1995/B903).
Received for publication Nov. 24, 1997. Revisions requested Jan. 15, 1998; revisions received Feb. 13, 1998. Accepted for publication Feb. 13, 1998. Address for reprints: Erik W. L. Jansen, MD, Heart-Lung Institute, Utrecht University Hospital (Room E03.406), P.O. Box 85500, 3508, GA Utrecht, The Netherlands.
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 2.3 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.
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