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Right Heart Support During Off-Pump Coronary Artery Bypass Surgery--A Multi-Center Study
(#2001-46467 ... October 13, 2001)
Ram Sharony, MD1, Rudiger Autschbach, MD, PhD2, Eyal Porat, MD1, Martin Struber, MD3, Andreas Boening, MD4, Ralf Krakor, MD2, Axel Haverich, MD3, Jochen T Cremer, MD4, Nahum Nesher, MD1, Friedrich W. Mohr, MD, PhD2, Gideon Uretzky, MD1
1 Tel-Aviv Sourasky Medical Center, Israel
2 Heart Center, Leipzig, Germany
3 Hannover Medical School, Hannover, Germany
4 University Hospital, Kiel, Germany
ABSTRACT
Background: Off-pump coronary artery bypass (OPCAB) surgery for posterior and inferior wall vessels requires heart displacement, which leads to hemodynamic instability. Based on results indicating that displacement primarily alters right heart function, this study evaluates the safety and efficacy of right heart support during OPCAB surgery to the posterior and inferior wall vessels.
Methods: In a multi-center, prospective study, 25 patients underwent multi-vessel OPCAB surgery. Right heart support was carried out using the Enabler™ circulatory support system (Hemodynamics Systems Ltd., Upper Yokneam, Israel). Hemodynamic measurements were recorded at baseline and during heart displacement with and without right heart support.
Results: No mortality was recorded. Mean graft number was 2.25 ± 0.36. Inability to position the Enabler™ system occurred in five cases. Once the Enabler™ was properly positioned, there was no case of conversion to cardiopulmonary bypass (CPB) due to failure of the Enabler™ to provide adequate support. Cardiac index (CI) declined from 2.4 ± 0.5 L/min./m2 to 1.6 ± 0.6 L/min./m2 (p <0.05) during heart displacement and increased to 2.3 ± 0.6 L/min./m2 (p <0.05) following Enabler™ activation. Mean arterial blood pressure (MAP) dropped from 82 ± 18.6 mmHg to 53.1 ± 16.6 mmHg (p <0.001) during heart displacement and was restored to 69.8 ± 19.4 mmHg (p <0.001) with Enabler™ support.
Conclusions: Heart displacement caused a significant hemodynamic deterioration that was stabilized with right heart support. The Enabler™ system is safe and effective in facilitating multi-vessel OPCAB surgery. However, there are still serious technical problems during cannula insertion that cause an unacceptable failure rate of device utilization.
AUTHOR/ARTICLE INFORMATION
Presented at the seventh annual meeting of Cardiothoracic Techniques & Technologies (CTT), January 24-27, 2001, New Orleans, LA
Submitted October 12, 2001; accepted October 13, 2001.
Address correspondence and reprint requests to: Ram Sharony, MD, Department of Cardiothoracic Surgery, New York University, School Of Medicine, 28th Street & First Ave. New Bellevue, 15W16, New York, NY, Email: mailto:sharony@med.nyu.edu
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