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Cardiac Positioning using an Apical Suction Device
Maintains Beating Heart Hemodynamics
(#2002-01910 ... March 22, 2002)
Jerome Sepic, MD, Jon O. Wee, MD, Edward G. Soltesz, MD, Michael K. Hsin, MD,
Lawrence H. Cohn, MD, Rita G. Laurence, BS, Lishan Aklog, MD
Division of Cardiac Surgery , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
ABSTRACT
Background: Cardiac positioning during off-pump coronary
artery bypass (OPCAB) using deep pericardial sutures
(DPS) typically results in some degree of hemodynamic compromise.
We sought to determine whether cardiac positioning
using an apical suction device was hemodynamically superior
to DPS.
Methods: Five healthy pigs underwent sternotomy and
instrumentation to measure right atrial (RA) pressure, left
ventricular (LV) pressure and volume, and aortic pressure
and flow. These variables were recorded at baseline, with
simple attachment of the apical suction device (Xpose™
Access Device, Guidant, Inc.), and during exposure of the posterior
descending artery (PDA) and obtuse marginal (OM)
branches of the left circumflex artery using DPS and the apical
suction device.
Results: Application of the apical suction device to the
beating heart in neutral anatomic position did not result in
any statistically significant change in hemodynamics compared
to baseline except for a small decrease in RA pressure.
DPS positioning resulted in statistically significant compromise
in nearly all measured hemodynamic parameters,
including cardiac output (-21% PDA, -30% OM), mean arterial
pressure (-18% PDA, -26% OM), and stroke work (-31%
PDA, -38% OM). In addition, LV end-diastolic pressure
decreased (-59% PDA, -51% OM) while RA pressure
increased (+17% PDA, +16% OM). Similar target exposure
using the apical suction device resulted in near-baseline
hemodynamics. The only statistically significant changes
were a modest decrease in cardiac output (-18% OM) and RA
pressure (-11% PDA).
Conclusion: DPS positioning significantly compromises
hemodynamics due to reduced LV filling. The apical suction
device provides good exposure with less hemodynamic compromise.
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