European Journal of Cardio-Thoracic Surgery, Vol 12, 406-412, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method
EW Jansen, PF Grundeman, C Borst, F Eefting, J Diephuis, A Nierich, JR Lahpor and JJ Bredee
Division of Cardiothoracic Surgery, Heart-lung Institute, University Hospital, Utrecht, Netherlands.
OBJECTIVE: Target site immobilization is essential to enable meticulous
anastomosis suturing during coronary artery bypass grafting on the beating
heart. A novel device ('Octopus') was developed for local heart muscle
immobilization by suction. The purpose of this study was to investigate the
efficacy of the method through a limited access. METHODS: The suction
device, placed on either side of the recipient coronary artery and fixed to
the operating table-rail through an arm construction, restrains anastomosis
site motion to 1 x 1 mm. A total of 27 patients underwent off-pump arterial
bypass grafting using this method. Preoperatively, all patients had angina
class III (NYHA) and were failed or unsuitable candidates for balloon
angioplasty. Surgical access was via a 10-cm anterior thoracotomy (n = 26)
or 10-cm subxiphoid incision (n = 1). RESULTS: Harvesting of the graft
required 48 +/- 12 min (mean +/- S.D.). Immobilization with the 'Octopus'
was effective and facilitated precise anastomosis suturing of 20 single and
7 sequential grafts. Immobilization did not change cardiac index and mean
arterial blood pressure. During coronary surgery, however, inotropic drug
support was used in 5 of 27 (18%) of patients. There was no myocardial
infarction. Only minor transient complications were met. There were
electro-cardiographical signs of pericarditis in 6 patients. The
postoperative hospital stay ranged from 2 to 6 days, mean 4.0 +/- 1.2 days.
The mean follow-up is 6.5 +/- 4 months (range, 1-12 months). All patients
except one were in functional class I without angina. Social activities
were resumed within 4 weeks. At 6 months angiography was performed in 15
out of 27 patients. The patency rate of 19 out of 20 anastomoses was 95%.
All distal grafts were patent. One side to side anastomosis was occluded.
CONCLUSIONS: The 'Octopus' immobilization method is safe and effective. It
facilitates less invasive CABG in selected patients and gives way to fast
recovery by reducing invasiveness.
