Tokujiro Uchida1, Hirokuni Arai2, Megumi Ohata1, Akihide Yamashita1, Hiroyuki Tanaka2, Koshi Makita1.
1Dept of Anesthesiology, Tokyo Medical & Dental University, Tokyo, Japan, 2Dept of Cardiothoracic surgery, Tokyo Medical & Dental University, Tokyo, Japan.
Multi-suction heart positioner Tentacles is a useful device to maintain the hemodynamic stability during the exposure of target vessels in the off-pump coronary artery bypass surgery. However, the left ventricular (LV) wall motion of the heart positioned by Tentacles have not been elucidated.
OBJECTIVE: To compare LV wall motion between the cases operated with Tentalces and those with LIMA suture by 3D-echocardiography, and to analyze the LV volume during exposure of target vessels.
METHODS: Twelve patients (Tentacles 8; LIMA 4) were studied with 3D transesophageal echocardiography (Sonos 7500 and T6H probe: Philips) and off-line reconstruction was performed with TOMTEC 4D Echo-View 5.2.
RESULTS: Stabilization of the site of anastomosis restricted LV wall motion, and cardiac positioning with Tentacles helped left ventricular compensating wall motion. LAD; Traction of the heart by Tentacles made enough space for the diastolic movements of lateral wall which compensated restricted septal movement due to the stabilization. RCA; Holding the right ventricle by Tentacles helped LV posterolateral movements in the diastolic phase and it helped maintaining stroke volume. LCX region; Stabilization of the lateral wall forced the diastolic septal movement to the right ventricular direction, which restricted LV diastolic movement. However, Tentacles maintained both diastolic movements on the short axis and apical movement on the long axis, which contributed to the maintenance of the cardiac function. During LCX exposure, LV stroke volume reduction was milder in the patients operated with Tentacles than those with LIMA (19.6±10.6% vs. 42.8±4.4% p<0.01, Figure)
CONCLUSIONS: Stroke volume reduction is a main feature of hemodynamic derrangement during LCX grafting. Tentacles contributed to keep LV diastolic volume, and prevented stroke volume reduction during LCX grafting. 
Back to 2008 Annual Meeting
Back to Program Outline