Off-Pump Arterial Revascularization Using a New Reusable Device for Coronary Occlusion and Local Stabilization.
Abstract Background: Optimal local stabilization, an unobstructed view, and a free field for operation are of most importance during off-pump surgery to facilitate high-quality anastomoses. We report on a new reusable stabilizing platform for complete off-pump coronary revascularization. Methods: From May 2001 until June 2002, 118 consecutive patients (82 men, 36 women) with coronary artery disease (61 with 1-vessel, 42 with 2-vessel, and 15 with 3-vessel disease) and a mean age of 63. 6 +/- 10. 0 years (range, 41-88 years) were scheduled for complete off-pump arterial revascularization. The mean left ventricular ejection fraction was 56. 5% +/- 12. 5%(range, 25%-85%). Exposure of the coronary vessels was facilitated with deep pericardial slings. The target coronary vessel was snared twice with air-cushioned silicone loops and fixed to the platform, which was connected to a flexible steel arm. The platform is available in 3 versions with different connector angles to accommodate various anatomical conditions. Together with its flat design, the platform provides an unobstructed view and a free field of operation. Results: All operations were performed without any intraoperative complications, and all planned bypasses were carried out. The mean number of bypass grafts was 1. 7 +/- 0. 8 (range, 1-5). There was no early (30 days) mortality. The postoperative course was uneventful in all patients except for 1 reexploration for retrosternal bleeding, 10 patients with temporary atrial fibrillation, and 1 patient with reintubation after early extubation in the operating room because of respiratory insufficiency. Patients were discharged from the hospital in good condition 8. 7 +/- 2. 6 days (range, 5-18 days) after surgery. Conclusions: Our data indicate that complete arterial off-pump revascularization can be performed safely and effectively with a new reusable platform that provides excellent stabilization and an unobstructed view to the target coronary vessels.