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Eur J Cardiothorac Surg 2007;32:604-610. doi:10.1016/j.ejcts.2007.07.009
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

A three-dimensional echocardiographic comparison of a deep pericardial stitch versus an apical suction device for heart positioning during beating heart surgery

^a Department of Anaesthesia and Intensive Care, Harefield Hospital, Harefield, United Kingdom
^b Department of Surgical Oncology and Technology, Imperial College of Science, Technology and Medicine, St. Mary's Hospital, London, United Kingdom
^c Department of Surgery, Harefield Hospital, Harefield, United Kingdom

Received 15 May 2007; received in revised form 5 July 2007; accepted 6 July 2007.

^_* Corresponding author. Address: Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, United Kingdom. Tel.: +44 1895 828946; fax: +44 1895 828965. (Email: shanegeorge{at}btinternet.com).

Background: Heart positioning during beating heart surgery produces significant haemodynamic compromise either when a deep pericardial stitch (DPS) or apical suction devices (ApSDs) are used. In this study the two techniques’ haemodynamic performance and effect on intracardiac structures were compared through transoesophageal echocardiography (TEE) obtained volume measurements and three-dimensional ventricular and mitral valve computer reconstructions. Methods: Sequential 0° to 180° TEE images of the left heart were obtained in 10 patients undergoing beating heart surgery. Measurements with both techniques in three different positions were obtained: at baseline, the heart elevated to access its inferior surface and the heart elevated and rotated to access its lateral surface. Three-dimensional computer reconstructions of the mitral valve and the left heart were generated. Ventricular volume measurements were used to calculate stroke volume, ejection fraction and differences from baseline. An analysis of variance between each technique in all three positions was performed. Results: Central venous, left atrial and pulmonary artery pressures were significantly increased with either technique during positioning. Both techniques significantly affected left ventricular function decreasing stroke volume and ejection fraction. In the vertical and rotated position, the ApSD produced a significant decrease from baseline both in stroke volume (DPS: 32.8 ± 18.7 vs ApSD: 55.46 ± 21.7; p = 0.02) and in ejection fraction (DPS: 19.3 ± 10.5 vs ApSD: 40.9 ± 24.6; p = 0.02). The three-dimensional reconstructions demonstrated significant distortion of the atrioventricular geometry and the mitral valve, which was more pronounced with the DPS. Conclusion: Both techniques produce variable degrees of deformation with associated cardiac dysfunction and haemodynamic instability. Cardiac function is impeded more with an ApSD with the heart elevated and rotated.

Key Words: Beating heart surgery • Three-dimensional echo • Deep pericardial stitch • Apical suction device