Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device ("Octopus")

Departments of Cardiology and Cardiopulmonary Surgery, Heart Lung Institute, Utrecht University Hospital, The Netherlands.

OBJECTIVE: This study assessed the feasibility of coronary artery bypass grafting on the beating heart without interruption of native coronary blood flow using a novel anastomosis site restraining device. BACKGROUND: Recently, an end-to-side bypass technique was described that does not require interruption of flow in the recipient artery. METHODS: By means of a suction device ("Octopus"), in 31 pigs the epicardium was grasped and immobilized through an arm contraption fixed to the operating table. In the first 15 consecutive pigs (study I), the two-dimensional motion of an epicardial beacon was monitored. In 16 subsequent pigs (study II), an internal mammary artery was grafted under the microscope in two steps to a proximal coronary artery segment, without cardiopulmonary bypass. First, the internal mammary artery was sutured end-to-side to the outside of the coronary artery. Secondly, an orifice was punched in the partitioning coronary wall by an excimer laser catheter introduced through a temporary side-branch of the internal mammary artery. RESULTS: Study II: During 43 suction periods in four anastomosis areas, immobilization was achieved for 15 to 169 min (>30 h in total) in 13 open- and 9 closed-chest procedures without hemodynamic deterioration. The area circumscribed by the edges of the beacon trajectory (area in which the anastomosis is to be tracked) was reduced from 73.0 +/- 43.0 mm(2) (mean +/- SD) to 1.3 +/- 0.5 mm(2) (p<0.001) in the open-chest and to 0.2 +/- 0.2 mm(2) in the closed-chest procedure. At 6 weeks, no myocardial or coronary suction lesions were found. Study II: Nonocclusive anastomosis surgery required 25 +/- 3 min. No leakage, serious arrhythmias, graft closure or hemodynamic deterioration occurred during the procedure or for 2 h after ligating the coronary artery proximally. At 6 weeks, all seven grafts were patent. CONCLUSIONS: Coronary bypass on the beating heart without interruption of coronary flow is feasible. In both open- and in closed-chest procedures, the "Octopus" reduced anastomosis site motion to about 1 X 1 mm without adverse consequences.

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