ISMICS: ISMICS 2007 Annual Meeting Hemodynamic study during OPCAB surgery using a new positioning device

Hemodynamic study during OPCAB surgery using a new positioning device

Jan M. Abicht¹, Hirokuni Arai², Sandra Eifert³, Andres Beiras³, Bruno Reichart³, Frank Christ¹, Calin Vicol³.
¹Anaesthesiology, Ludwig Maximilians University Munich, Munich, Germany, ²Cardiothoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan, ³Cardiac Surgery, Ludwig Maximilians University Munich, Munich, Germany.

Objective: Optimal positioning of the heart and exposure of the target coronary arteries while performing OPCAB surgery should not impair circulatory stability. We performed a hemodynamic study while using a new positioning device for revascularization of all areas of the coronary system.
Methods: Tentacles a three armed suction device was used for positioning the heart and Octopus was used for stabilization of the target coronary artery. Forty seven patients were enrolled. To survey hemodynamic continuous cardiac index (CCI), mean arterial pressure (MAP) and the amount of administered catecholamines were recorded for each positioning of the heart. Positioning of the heart was grouped by the target vessel: A = left anterior descending and diagonal branches, B = circumflex artery and marginal branches and C = right coronary artery and end branches.
Results: The average number of distal anastomoses per patient was 2.7. Conversion rate to on-pump surgery was 0. The device enabled rapid, secure and excellent exposure of all target areas. No detachment of the suction heads was observed even in large hearts. Before temporary closure of the target coronary artery preconditioning was performed for 2 min. Intracoronary shunts were not used. The mean anastomotic time was 09:54 min. In any position of the heart neither CCI, MAP changed significantly compared to the physiologic position of the heart (baseline). However, small amount of vasopressors was used during positioning of the heart.


Position	Baseline	A	B	C
MAP (mmHg)	79 (±13)	75 (±8)	72 (±9)	75 (±9)
		p = 0.27	p = 0.10	p = 0.40
CCI (l/min/m²)	3.1 (±0.53)	3.0 (±0.45)	3,0 (±0.64)	2,86 (±0.64)
		p = 0.69	p = 0.81	p = 0.45
Norepinephrin (μg/kg/min)	0.02(±0.02)	0.06 (±0.04)	0.06 (±0.03)	0.07 (±0.03)
		p < 0.05	p < 0.05	p < 0,05

Sinus rhythm was present throughout the measurements. No significant changes of the ST-T segment in the ECG nor changes in ventricular wall motion or important mitral valve insuffiency were observed in TEE.
Conclusions: Our study proved the efficacy of the Tentacles heart positioner, which enables excellent and safe access to all target coronary arteries during OPCAB surgery. Circulatory stability was constant during the whole procedure.

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