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Eur J Cardiothorac Surg 2003;24:762-769
© 2003 Elsevier Science NL

Right heart assist for beating heart coronary artery bypass grafting

^a Department of Cardiothoracic and Vascular Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
^b Institute for Experimental Clinical Research, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
^c Department of Anaesthesiology, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
^d Department of Thoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark

Received 22 October 2002; received in revised form 24 April 2003; accepted 21 July 2003.

^* Corresponding author. Department of Thoracic Surgery 2152, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark. Tel.: +45-3545-2516; fax: +45-3545-2548
e-mail: phughes{at}rh.dk

Objective: Cardiopulmonary bypass used in conventional coronary artery bypass surgery (cCABG) entails a risk of complications. Consequently, the trend is moving towards off-pump coronary artery bypass (OPCAB). This procedure, however, may lead to haemodynamic instability due to kinking of the right ventricle when the posterior aspect of the heart is exposed. The aim of the study was to establish if a right-sided circulatory assist device (RHA) was able to maintain haemodynamic stability during OPCAB procedures. Method: In a prospective study 50 RHA-OPCAB patients and a control group of 50 cCABG patients were examined. Before accessing the marginal arteries, an RHA was established in the RHA-OPCAB patients. Results: A stable haemodynamic condition was achieved for 98% of the RHA-OPCAB patients. The study group had less postoperative chest drain bleeding (P<0.001), shorter ventilation time (P=0.001), and lower blood levels of creatine kinase (CK) and brain CK (P<0.001) compared to the control group. Conclusion: The results indicate that RHA-OPCAB is a realistic alternative to cCABG. The procedure can be safely performed most likely resulting in reduced postoperative bleeding, myocardial damage, and ventilation time.

Key Words: Off pump coronary artery bypass • Coronary artery bypass surgery • Right heart assist

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