Hemodynamic effects of elevation and stabilization of the heart during off-pump coronary surgery

Background: Coronary artery bypass grafting (CABG) surgery is now being per formed without the use of cardiopulmonary bypass (CPB). To achieve complete myocardial revascularization off-CPB, a technique has been developed to ex pose target coronary arteries while hemodynamics are maintained. Methods: C omplete myocardial revascularization was performed in 18 consecutive patien ts. Exposure of target coronary arteries was achieved by a "single-suture" technique, placed in the oblique sinus of the pericardium. Traction on the suture elevates and rotates the heart, thereby exposing all target coronary arteries. Cardiac index (CI) and intracardiac pressures were measured with a Swan-Ganz catheter during the different phases of the operation. Results : All patients were successfully operated on without CPB. There were no pos toperative complications or deaths. There were no major hemodynamic changes during the different stages of the operation; in other words, Cl was uncha nged during elevation of the heart and snaring of the main coronary branche s. Pulmonary artery wedge pressure (PAWP) increased markedly during occlusi on and stabilization of the circumflex coronary artery (p < 0.05). A marked increase in Cl and cardiac output (CO) from baseline values was also recor ded before chest closure (p < 0.05). Conclusion: Complete myocardial revasc ularization can be achieved safely without CPB. The single-suture technique allows for exposure of all target coronary arteries without hemodynamic co mpromise.