Hemodynamic changes during displacement of the beating heart by the Utrecht Octopus method

Gründeman, Paul F.; Borst, Cornelius; Herwaarden, Joost A. van; Beck, Hendricus J. Mansvelt; Jansen, Erik

doi:10.1016/s0003-4975(97)00339-1

Cited by 131 publications

(86 citation statements)

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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.…”

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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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Section: See P 1743mentioning

confidence: 99%

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

et al. 2001

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“…In addition to the parameters of Sv O 2 ≤ 70%, and Pa CO 2 ≤ 40 mmHg, our study also revealed that CVP ≥ 8 mmHg was significantly associated with jugular bulb desaturation. In regard to CVP, it is generally accepted that hemodynamic deterioration during OPCAB is due to the effect of cardiac displacement and inevitable pressure applied to the heart, both of which can affect ventricular function and coronary artery blood fl ow during anastomoses of the right coronary artery (RCA) or CX [23][24][25]. Kwak and colleagues [26] demonstrated that significantly reduced right ventricular ejection fraction accompanied by an increase of right ventricle afterload and decreased cardiac index (CI) were observed during heart displacement.…”

Section: Discussionmentioning

confidence: 99%

Jugular bulb desaturation during off-pump coronary artery bypass surgery

et al. 2009

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“…Exposing posterior branches by displacing the beating heart (apex points anteriorly) tends to decrease arterial pressure both in the pig model 11 and in patients. 12 Experimentally, Grundeman, 11 and Jansen et al 12 have reported the feasibility of immobilizing the posterolateral cardiac wall with the straight Octopus paddle fixed directly on the ventricle.…”

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confidence: 99%

Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

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et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the mechanisms of hemodynamic changes during off-pump coronary artery bypass graft surgery (OP-CABG).S So ou ur rc ce e: : Pertinent medical literature in the English and French languages was identified through a Medline computerized literature search and a manual search of selected articles, using off-pump coronary artery surgery, beating heart surgery, hemodynamic, and transesophageal echocardiography as key words. Human and animal studies were included. P Pr ri in nc ci ip pa al l f fi in nd di in ng g: : Hemodynamic variations in OP-CABG may be due to mobilization and stabilization of the heart, or myocardial ischemia occurring during coronary occlusion. Suction type and compression type stabilizers produce hemodynamic effects through different mechanisms. Heart dislocation (90° anterior displacement) and compression of the right ventricle to a greater extent than the left ventricle are responsible for hemodynamic alterations when using suction type stabilizers. Compression of the left ventricular outflow tract and abnormal diastolic expansion secondary to direct deformation of the left ventricular geometry are proposed mechanisms for hemodynamic derangements with compression type stabilizer. Coronary occlusion during the anastomosis can have additional effects on left ventricular function, depending on the status of collateral flow. The value and limitations of electrocardiographic (ECG), hemodynamic and echocardiographic monitoring modalities during OP-CABG are reviewed.C Co on nc cl lu us si io on ns s: : In summary, hemodynamic changes which can either be secondary to the stabilization technique or to transient ischemia represent an important diagnostic challenge during offbypass procedures. The mechanism can vary according to the stabilization system. Current monitoring such as ECG and hemodynamic monitoring are used but remain limited in establishing the cause of hemodynamic instability. Transesophageal echocardiography is used in selected patients to diagnose the etiology of hemodynamic instability and can direct therapy, particularly in those with severe myocardial systolic and diastolic dysfunction, mild to moderate mitral regurgitation, or for patients who are unstable during the procedure. Objectif : Décrire les mécanismes de changements hémodynamiques pendant le pontage aortocoronarien (PAC-CB). Source : La documentation pertinente en anglais et en français a été

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Hemodynamic changes during displacement of the beating heart by the Utrecht Octopus method

Cited by 131 publications

References 13 publications

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

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

Jugular bulb desaturation during off-pump coronary artery bypass surgery

Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery

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