Right heart circulatory support facilitates coronary artery bypass withoutcardiopulmonary bypass

Background. Revascularization of the posterior wall often causes hemodynami c instability in beating heart coronary artery bypass (CAB). Our previous c linical studies have shown that tilting the heart primarily alters right-he art hemodynamics. The purpose of this study was to evaluate right-heart sup port in clinical cases. Methods. Seventeen patients underwent beating heart CAB with right-heart su pport. The right-heart support system (A-Med Systems, West Sacramento, CA) consisted of a coaxial cannula placed through the right atrium and the tip of the cannula positioned in main pulmonary artery. Blood was removed from the right atrium and returned to the main pulmonary artery. Results. Elective beating heart CAB was accomplished successfully in 17 pat ients with right-heart support. Anastomoses performed were left anterior de scending coronary artery (11), diagonal (3), circumflex (5), obtuse margina l artery (11), and right coronary artery (10). Right-heart support between 1 and 3 L/min improved hemodynamics especially in the circumflex position. No device-related patient incidents occurred, nor were there incidents of i nfection or air embolism. All 17 patients were discharged to their homes. Conclusions. The right-heart support system was safe without complications. Exposure of the posterior wall was possible in all cases without hemodynam ic compromise. (Ann Thorac Surg 2000;70:1083-5) (C) 2000 by The Society of Thoracic Surgeons.