Off-pump multivessel coronary artery bypass utilizing the Octopus tissue stabilization system: initial experience in 374 patients from three separate centers.
BACKGROUND: Renewed interest in coronary artery bypass without heart-lung support has lead to the development of specialized instrumentation to permit surgical exposure and grafting in all territories of the beating heart. This report summarizes the results of a multicenter, prospective trial using a single system of mechanical stabilization for multivessel revascularization without cardiopulmonary bypass. METHODS: Three principal investigators at different institutions performed off-pump coronary grafting utilizing the Medtronic Octopus suction stabilization system which provides a motionless region encompassing the target coronary artery. Positioning and stabilization strategies evolved during the trial but eventually lead to a consistent approach for accessing all regions of the heart. Clinical data sets were collected prospectively and pooled for evaluation of early and short-term endpoints of success. RESULTS: A total of 374 patients underwent beating heart coronary bypass procedures with only a single death for an in-hospital 30-day mortality rate of 0.26%. There were 140 single-vessel revascularizations (37.4% of patients), 119 double coronary grafts (31.8%), 90 triple-vessel grafts (24.1%), and 25 four-vessel grafts (6.7%), for a mean of 1.96 grafts per patient. If the single vessel cases are removed from analysis, the mean number of grafts performed in the multivessel cohort was 2.6 grafts per patient. All anatomic regions of the heart were successfully grafted including traditionally difficult locations such as the obtuse marginal branches of the circumflex and posterior descending branches of the right coronary artery. Only one patient suffered a new neurologic deficit which occurred 15 days postoperatively, for an overall incidence of only 0.26%. No patient required a new intra-aortic balloon pump or dialysis for renal insufficiency. The incidence of atrial fibrillation (12.8%) was age related and essentially unchanged from the overall incidence observed in patients operated at the same institutions using conventional techniques. CONCLUSIONS: Multivessel grafting on the beating heart using the Octopus stabilization system results in remarkably low perioperative mortality and morbidity, with very low incidences of cerebrovascular, renal, and respiratory complications. However, the incidence of postoperative atrial fibrillation is not reduced. Expanded clinical use of beating heart surgery with suction-based stabilization appears to be a promising technique for achieving global revascularization without the need for cardiopulmonary bypass.