Exposure of circumflex branches in the tilted, beating porcine heart: Echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass

Gründeman, Paul F.; Borst, Cornelius; Verlaan, Cees W.J.; Meijburg, Huub W.; Mouës, Chantal M.; Jansen, Erik

doi:10.1016/s0022-5223(99)70222-9

Cited by 127 publications

(63 citation statements)

References 11 publications

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“…Hemodynamic deterioration is primarily caused by right ventricular dysfunction, resulting from compression of the right heart chambers against the surrounding fibrous pericardium and pleura. 26 These hemodynamic changes are more pronounced when extensive cardiac manipulation is required to expose a target vessel on the posterolateral aspect of the heart, and are generally reversible once the heart is replaced in its normal position. Thus, in terms of stress hormone response, the benefits conferred by avoiding CPB might be negated by the cumulative hemodynamic stress of OPCAB surgery.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Song

Lee

et al. 2008

Circ J

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Background Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. Methods and ResultsThe study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. Conclusions Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored. (Circ J 2008; 72: 1966 -1974

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Section: Discussionmentioning

confidence: 99%

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Song

Lee

et al. 2008

Circ J

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“…9,12 The feasibility of off-pump CABG depends primarily on the coronary anatomy and the hemodynamic consequences of exposure of the posterior ventricular wall. 9,13,14 The procedure is technically more demanding, and it is unknown whether cardiac outcome is comparable to on-pump procedures. 9 This randomized trial compared off-pump and on-pump CABG.…”

Section: See P 1743mentioning

confidence: 99%

Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery

et al. 2001

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Background-The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure. Methods and Results-In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (PϽ0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (PϽ0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (Pϭ0.66). Conclusions-In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of

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“…9 First, midsternotomy was performed to allow easy instrumentation for hemodynamic measurements and time saving open-chest harvesting of the internal mammary arteries. After sternal closure, the amount of retrosternal working space was comparable with the space created after endoscopic dissection of mediastinal tissue and opening of the pleural spaces as performed in pilot studies.…”

Section: Anesthesia and Instrumentationmentioning

confidence: 99%

Endoscopic Exposure and Stabilization of Posterior and Inferior Branches Using the Endo-Starfish Cardiac Positioner and the Endo-Octopus Stabilizer for Closed-Chest Beating Heart Multivessel CABG: Hemodynamic Changes in the Pig

et al. 2003

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Background-Closed-chest, off-pump, multivessel CABG requires modified instruments to expose and stabilize posterior and inferior coronary branches. Using three new prototype devices, we explored the feasibility of endoscopic bypass grafting on these branches and assessed cardiac function during cardiac displacement. Methods-Eight pigs (75 to 85 kg) were instrumented for hemodynamics and paced at 80 to 100 bpm. After closure of the sternotomy wound, the Da Vinci endoscope was inserted subxiphoidally. A sternal hook was used to hoist the sternum ventrally by 5 cm. The articulating EndoStarfish cardiac positioner was placed through a trocar (Ø12 mm). The positioner was fixed to the apex using -400 mm Hg suction and the heart was displaced anteriorly to 90 degrees. In 12 other pigs (75 to 85 kg), both internal mammary arteries (IMA) were harvested and the sternal wound was closed. Five trocar ports were placed for instrumentation (Ø12 mm, two in left chest, two in right chest, and one subxiphoidally). For coronary stabilization, a novel deployable EndoOctopus cardiac stabilizer was employed (suction -400 mm Hg). The Da Vinci robot-telemanipulator system was used for endoscopic grafting of the left and right IMA on posterior and inferior branches (16 anastomoses). Results-When circumflex arteries were fully exposed and accessible for coronary surgery, stroke volume decreased by 18%Ϯ3 versus baseline (Pϭ0.02) and mean arterial pressure decreased by 27%Ϯ6 (Pϭ0.001). Additional 10 degrees Trendelenburg head-down positioning normalized stroke volume and arterial pressure. In the displaced heart, obtuse marginal branches (OM) and the ramus descending posterior (RDP) of the right coronary artery became fully exposed with a mean arterial pressure Ͼ70 mm Hg during grafting. No accidental detachment occurred. Coronary target motion was restrained to approximately 1ϫ1 mm. In two test cases, five sham distal anastomoses were created (grafts sewn to epicardium, left IMA to OM2 jump to OM3, right IMA to RDP, and composite graft from left IMA jump to diagonal branch). In 10 animals, 16 successfully completed anastomoses to RPD and OM branches of Ø1.75 to 2.5 mm required 25 to 60 minutes each to construct. At sacrifice, all anastomoses were patent. Conclusion-In

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Exposure of circumflex branches in the tilted, beating porcine heart: Echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass

Cited by 127 publications

References 11 publications

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Perioperative Indicators of Stress Response and Postoperative Inflammatory Complications in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery A Prospective Observational Study

Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery

Endoscopic Exposure and Stabilization of Posterior and Inferior Branches Using the Endo-Starfish Cardiac Positioner and the Endo-Octopus Stabilizer for Closed-Chest Beating Heart Multivessel CABG: Hemodynamic Changes in the Pig

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