TRANSIENT VENTRICULAR ASYSTOLE USING ADENOSINE DURING MINIMALLY INVASIVE AND OPEN STERNOTOMY CORONARY-ARTERY BYPASS-GRAFTING

Background. The emergence of minimally invasive coronary artery bypass grafting and recent off-pump open sternotomy clinical reports have re focused attention on the technical aspects and outcome of grafting on the beating heart. Methods. To optimize the surgical field we report a method using adenosine for induction of controlled intervals of ventr icular asystole to produce a transiently still cardiac field that faci litates anastomotic accuracy. Results. Adenosine was used in 57 patien ts, 31 included off-pump coronary artery bypass grafting (27 by minima lly invasive technique, 4 by open sternotomy). In a further 26 patient s adenosine pauses were used for suture placement to control anastomot ic bleeding after cardiopulmonary bypass. Average adenosine boluses pe r anastomosis were 9 (6-14), mean dose of adenosine per bolus (mg/kg) was 0.24 (0.15-0.35), mean duration of pause (seconds) was 6 (3-19), a nd mean time for arterial blood pressure (mean) to return to baseline (seconds) was 35 (13-48). Presence of repolarization arrhythmias was n oted in 1 patient. There were no deaths. Two patients had recurrent my ocardial ischemia shown on angiography to be the result of technical p roblems. Conclusions. This report describes our experience with the em erging procedure of minimally invasive coronary operations and off-pum p grafting with the adenosine technique. The method also includes mech anical devices and other pharmacological therapy to optimize the surgi cal field, and the technique has now become a standard component of ou r elf-pump revascularization methods. (C) 1997 by The Society of Thora cic Surgeons.