T H Spooner1, J C Hart, J Pym. 1. Park Nicollet Clinic, HealthSystem Minnesota, Minneapolis 55426, USA. tspooner@aol.com
Abstract
BACKGROUND: The popularity of beating heart coronary artery bypass (CAB) has grown with the development of mechanical stabilizers. Multicenter study offers an opportunity to examine methods and risk relating to this practice. METHODS: The experience since March 1997, utilizing both the original Medtronic Octopus system and the second-generation, retractor-mounted, Octopus II for beating heart CAB (Medtronic, Inc, Minneapolis, MN), was retrospectively reviewed at three institutions. RESULTS: Four hundred fifty-six patients completed Octopus CAB (Medtronic, Inc), performed through left thoracotomy (54), partial (33), or full (374) sternotomy, and epigastric (3) incisions with an average of 1.9 grafts/patient. Morbidities were reviewed: transfusion (20.6%), reoperation for bleeding (1.0%), atrial fibrillation (13.3%), completed stroke (0.2%), perioperative myocardial infarction (0.8%), and new intraaortic balloon pump (IABP) (0.4%), without episodes of deep sternal infection or renal failure. The mortality rate (0.32%), when compared to the Society of Thoracic Surgeons' (STS)-predicted mortality (1.37% and 2.36%) at two institutions, was significantly less (p < 0.05). Twelve nonurgent and one urgent conversion to cardiopulmonary bypass occurred. Six patients have required reintervention on bypassed vessels. CONCLUSIONS: To facilitate lateral and inferior wall grafting, a variety of techniques were utilized, including positioning, sternal and pericardial mobilization, and a new pericardial-based sling retractor, all designed to improve exposure while maintaining hemodynamic stability. The Octopus devices were safely applied with low morbidity and mortality utilizing varied operative approaches at three institutions.
BACKGROUND: The popularity of beating heart coronary artery bypass (CAB) has grown with the development of mechanical stabilizers. Multicenter study offers an opportunity to examine methods and risk relating to this practice. METHODS: The experience since March 1997, utilizing both the original Medtronic Octopus system and the second-generation, retractor-mounted, Octopus II for beating heart CAB (Medtronic, Inc, Minneapolis, MN), was retrospectively reviewed at three institutions. RESULTS: Four hundred fifty-six patients completed Octopus CAB (Medtronic, Inc), performed through left thoracotomy (54), partial (33), or full (374) sternotomy, and epigastric (3) incisions with an average of 1.9 grafts/patient. Morbidities were reviewed: transfusion (20.6%), reoperation for bleeding (1.0%), atrial fibrillation (13.3%), completed stroke (0.2%), perioperative myocardial infarction (0.8%), and new intraaortic balloon pump (IABP) (0.4%), without episodes of deep sternal infection or renal failure. The mortality rate (0.32%), when compared to the Society of Thoracic Surgeons' (STS)-predicted mortality (1.37% and 2.36%) at two institutions, was significantly less (p < 0.05). Twelve nonurgent and one urgent conversion to cardiopulmonary bypass occurred. Six patients have required reintervention on bypassed vessels. CONCLUSIONS: To facilitate lateral and inferior wall grafting, a variety of techniques were utilized, including positioning, sternal and pericardial mobilization, and a new pericardial-based sling retractor, all designed to improve exposure while maintaining hemodynamic stability. The Octopus devices were safely applied with low morbidity and mortality utilizing varied operative approaches at three institutions.