Acute effects of beating heart coronary surgery on left ventricular performance.

BACKGROUND: The increasing use of off-pump bypass grafting (OPCABG), requires an evaluation of its effects on left ventricular (LV) performance. METHODS: In 8 patients with multivessel coronary disease who were undergoing to off-pump coronary artery bypass grafting, LV performance was analyzed from the pressure-volume (P-V) plane by the conductance catheter technique. Measurements were performed at base line, after the exposure of the vessels, after the application of the stabilization system, and at the end of the procedure. RESULTS: No significant changes in heart rate, LV end-systolic volume, LV end-diastolic pressure, mean pulmonary artery, and mean systemic blood pressure were observed in the various stages of the procedure. Cardiac index decreased during left anterior descending coronary artery grafting after application of the stabilizer with a concomitant decrease in LV end-diastolic volume, together with decreases in LV peak negative -dP/dt and increases in tau, indicating an impairment of LV relaxation but without a change in preload recruitable stroke work, indicating preserved LV contractile state. Exposure of posterior and lateral vessels induced a decrease in cardiac index and preload recruitable stroke work without a decrease in LV preload, indicating a decrease in LV contractile state together with a decrease in peak -dP/dt and increase in tau, indicating an impairment in LV relaxation CONCLUSIONS: Off-pump coronary artery bypass grafting can be performed without decreasing LV performance. Major cardiac displacement like that used for posterior and lateral exposure induces acutely significant decrease in LV contractile state.

Off-pump coronary artery surgery with the use of anastomotic devices: an additional tool for the challenging patient.

BACKGROUND: Avoidance of aortic side-clamping may decrease the risk of embolization to the brain and other organs during coronary revascularization. Herein we describe our preliminary experience with an anastomotic device for proximal anastomosis construction. METHODS: From October 2000 to June 2001, 18 selected patients undergoing beating heart surgery had an aorta-to-saphenous vein graft anastomosis performed with the St. Jude Medical Aortic connector. RESULTS: All anastomoses were successfully deployed. In two patients there was a minor anastomotic bleeding and in other two cases a kinking occurred due to a too short and a too long graft respectively. One patient, with graft occlusion on the fourteenth postoperative day, underwent successful percutaneous revascularization. CONCLUSIONS: Our preliminary results indicate that the aortic anastomotic device is safe and effective and its use could be widened once long-term results are available.