TY - JOUR
T1 - Ninety-degree anterior cardiac displacement in off-pump coronary artery bypass grafting
T2 - The Starfish cardiac positioner preserves stroke volume and arterial pressure
AU - Gründeman, Paul F.
AU - Verlaan, Cees W.J.
AU - Van Boven, Wim Jan
AU - Borst, Cornelius
N1 - Funding Information: The University Medical Center Utrecht (UMCU) receives royalties from Medtronic for this invention; however, this research was performed independently, funded with academic grants. The present study was funded by a grant from the UMCU to Dr Borst. The UMCU receives royalties from the sales of the Octopus stabilizer and the Starfish positioner. As inventors, Drs Grundeman and Borst have received compensation from the UMCU. The authors have performed a free and in-depth evaluation of this new technology.
PY - 2004/8
Y1 - 2004/8
N2 - Purpose In off-pump coronary surgery through sternotomy, exposure of posterior circumflex branches causes circulatory deterioration in both patients and pigs. We assessed cardiac pump function when displacing the pig heart anteriorly with a suction cardiac positioner. Description Six pigs (±80 kg) underwent sternotomy for hemodynamic instrumentation using catheter-tipped manometers and paced at 80 beats/min. Ultrasound flow probes were placed around the aorta and proximal coronary arteries. The heart was retracted anteriorly to 90 degrees with the Starfish cardiac positioner attached to the apex by means of suction (-400 mm Hg). Retraction was guided by cardiac output monitoring. Evaluation Anterior displacement to 90 degrees facilitated full exposure of posterior arteries. Stroke volume and mean arterial pressure decreased to 94% ± 13% (mean ± SD, p = 0.135) and 95% ± 13% (p = 0.09) of control values, respectively. Right and left ventricular end-diastolic pressure increased to 129% ± 37% (p = 0.009) and to 128% ± 57% (p = 0.235), respectively. Coronary flow remained unchanged. Additional 15-degree head-down positioning increased stroke volume to 113% ± 17% (p = 0.015) and mean arterial pressure to 113% ± 25% (p = 0.087) at the expense of further increased right and left ventricular end-diastolic pressure (186% ± 63%, p < 0.001 and 157% ± 49%, p < 0.001, respectively). Conclusions When lifting the porcine heart ninety degrees anteriorly, the Starfish cardiac positioner facilitated exposure of posterior branches and, when guided by cardiac output, preserved stroke volume and arterial pressure.
AB - Purpose In off-pump coronary surgery through sternotomy, exposure of posterior circumflex branches causes circulatory deterioration in both patients and pigs. We assessed cardiac pump function when displacing the pig heart anteriorly with a suction cardiac positioner. Description Six pigs (±80 kg) underwent sternotomy for hemodynamic instrumentation using catheter-tipped manometers and paced at 80 beats/min. Ultrasound flow probes were placed around the aorta and proximal coronary arteries. The heart was retracted anteriorly to 90 degrees with the Starfish cardiac positioner attached to the apex by means of suction (-400 mm Hg). Retraction was guided by cardiac output monitoring. Evaluation Anterior displacement to 90 degrees facilitated full exposure of posterior arteries. Stroke volume and mean arterial pressure decreased to 94% ± 13% (mean ± SD, p = 0.135) and 95% ± 13% (p = 0.09) of control values, respectively. Right and left ventricular end-diastolic pressure increased to 129% ± 37% (p = 0.009) and to 128% ± 57% (p = 0.235), respectively. Coronary flow remained unchanged. Additional 15-degree head-down positioning increased stroke volume to 113% ± 17% (p = 0.015) and mean arterial pressure to 113% ± 25% (p = 0.087) at the expense of further increased right and left ventricular end-diastolic pressure (186% ± 63%, p < 0.001 and 157% ± 49%, p < 0.001, respectively). Conclusions When lifting the porcine heart ninety degrees anteriorly, the Starfish cardiac positioner facilitated exposure of posterior branches and, when guided by cardiac output, preserved stroke volume and arterial pressure.
KW - 23
UR - http://www.scopus.com/inward/record.url?scp=3242812205&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S0003-4975(03)01363-8
DO - https://doi.org/10.1016/S0003-4975(03)01363-8
M3 - Article
C2 - 15276546
SN - 0003-4975
VL - 78
SP - 679
EP - 684
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -