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Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method.

E W Jansen·P F Gründeman·C Borst·F Eefting·J Diephuis·A Nierich·J R Lahpor·J J Bredée
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Abstract

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.

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AdultAgedCoronary Artery BypassCoronary DiseaseFemaleFollow-Up StudiesHumansImmobilizationLength of StayMaleMiddle AgedMinimally Invasive Surgical ProceduresSeverity of Illness IndexSuctionThoracic ArteriesThoracotomyUltrasonographyJournal ArticleResearch Support, Non-U.S. Gov't

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E W Jansen, P F Gründeman, C Borst, F Eefting, J Diephuis, A Nierich, J R Lahpor, J J Bredée. 1997. Less invasive off-pump CABG using a suction device for immobilization: the 'Octopus' method.. https://doi.org/10.1016/s1010-7940(97)00200-5

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