Right heart assist ensures hemodynamic stability during beating heart coronary surgery on marginal arteries. An animal experimental porcine study

Objectives-In many heart centers myocardial revascularization using beating heart coronary surgery has partly replaced conventional coronary artery by pass grafting (cCABG) using cardiopulmonary bypass. However, access to the marginal arteries is problematic and hampered by space limitations, which m ight compromise the quality of the anastomoses and it entails a significant risk of hemodynamic instability subsequent to the manipulations of the hea rt. Hemodynamic impairment may be caused by dislocation of the low-pressure right atrium and ventricle. Therefore, it was hypothesized that the use of Right Heart Assist (RHA) may be able to ensure hemodynamic stability when tilting and manipulating the heart. Design-In an animal experimental model RHA was implemented in order to stud y the hemodynamic impact of dislocating the heart in a standardized fashion . Results-Dislocation of the unassisted heart to expose the first and second marginal branches caused a decline in arterial blood pressure, cardiac outp ut and venous saturation of 38-48%. Supported by RHA this decrease was mini mized to 0-17%. Conclusion-RHA for beating heart procedures indicates several advantages: a mple time and safety while making the anastomoses at the marginal branches, less space limitations and enhanced control of hemodynamic stability compa red with no RHA. This operation technique is challenging current practice a nd indications, and may potentially replace cCABG for the majority of patie nts.