A two-year, three institution experience with the medtronic octopus: Systematic off-pump surgery

Background. The popularity of beating heart coronary artery bypass (CAB) ha s grown with the development of mechanical stabilizers. Multicenter study o ffers an opportunity to examine methods and risk relating to this practice. Methods. The experience since March 1997, utilizing both the original Il Me dtronic Octopus system and the second-generation, retractor-mounted, Octopu s II for beating heart CAB (Medtronic, Inc, Minneapolis, MN), was retrospec tively reviewed at three institutions. Results. Four hundred fifty-six patients completed Octopus CAB (Medtronic, Inc), performed through left thoracotomy (54), partial (33), or full (374) sternotomy, and epigastric (3) incisions with an average of 1.9 grafts/pati ent. Morbidities were reviewed: transfusion (20.6%), reoperation for bleedi ng (1.0%), atrial fibrillation (13.3%), completed stroke (0.2%), perioperat ive myocardial infarction (0.8%), and new intraaortic balloon pump (IABP) ( 0.4%), without episodes of deep sternal infection or renal failure. The mor tality rate (0.32%), when compared to the Society of Thoracic Surgeons' (ST S)-predicted mortality (1.37% and 2.36%) at two institutions, was significa ntly less (p < 0.05). Twelve nonurgent and one urgent conversion to cardiop ulmonary bypass occurred. Six patients have required reintervention on bypa ssed vessels. Conclusions. To facilitate lateral and inferior wall grafting a variety of techniques were utilized, including positioning, sternal and pericardial mo bilization, and a new pericardial-based sling retractor, all designed to im prove exposure while maintaining hemodynamic stability. The Octopus devices were safely applied with low morbidity and mortality utilizing varied oper ative approaches at three institutions. (C) 1999 by The Society of Thoracic Surgeons.