A multicenter initial clinical experience with right heart support and beating heart coronary surgery

Background: During coronary surgery without CPB, exposure of posterior vess el via sternotomy can cause deterioration of cardiac hemodynamics requiring inotrope drugs support. Recent animal experiments demonstrate hemodynamic benefit of right heart support (RHS) with the AMED system. The purpose of this study was to evaluate the hemodynamic effects during ca rdiac manipulation to expose the posterior coronary arteries, and determine the effect of RHS in restoring hemodynamics, increasing anastomotic exposu re and reducing inotropic requirements. Material and Methods: From July 28 to December 29, 32 patients (25 men/ 7 w omen), mean age of 63.4 (+/- 6.2 years, ages: 49 - 78) received coronary re vascularization with the A-Med RHS device. They were divided into two group s of 16 patients, A and B. Group A patients had at least one circumflex bra nch bypassed. The anterior wall was systematically bypassed off-pump withou t RHS. The right coronary artery (RCA) and the obtuse coronary artery (OM) were completed utilizing RHS. In group B patients, all vessels including an terior vessels were bypassed with the RHS. Mean arterial pressure (MAP), mean pulmonary arterial pressure (PAP), cardi ac output (CO) and the average pump flow (APF) were recorded during the OM and RCA bypass for group A, and for group B LAD data was also recorded. Results: Elective beating heart coronary artery bypass graft (CABG) was suc cessfully accomplished in 32 patients with RHS. Data measurements recorded in Group A showed the improved hemodynamic recovery for OM and RCA bypass w ith RHS. The MAP increased from 44 to 68mmHg (OM) and from 63 to 81mmHg (RC A); the CO from 2.1 to 4.4 L/min (OM) and from 3.3 to 4.7 L/min (RCA). In g roup B, the data recorded showed the stability of the MAP in all vessels by passed (LAD, OM and RCA). No device-related patient incidents ocurred. All 32 patients were discharged to their homes. Conclusons: The AMED system, as RHS support, facilitated coronary bypass wi thout CPB to posterior vessels, restoring hemodynamics, providing better ex posure to anastomotic sites and apparently reducing inotropes need. Prospec tive randomize trials are necessary to confirm this initial experience.