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Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder.
Heart Surg Forum. 2001; 4(2):174-8.HS

Abstract

BACKGROUND

Can off-pump coronary artery bypass grafting become the routine standard in all elective primary coronary artery bypass grafting (CABG) operations? This paper shows how this aim has been achieved during one year in 130 off-pump cases performed through a sternotomy. This strategy allows for full revascularization (up to six grafts) without the disadvantage of cardiopulmonary bypass. The study introduces a variant of the Octopus stabilizer, a single Octopus 1 arm (Medtronic, Inc., Minneapolis, MN) with a dual holder.

MATERIALS AND METHODS

From November 1998 through February 2000, 130 patients underwent coronary artery bypass grafting through a sternotomy off-pump utilizing a stabilizer and CO2 blower. The stabilizer most frequently used to achieve this was a single Octopus 1 arm equipped with a dual holder to accommodate two straight suction pods. The holder allowed increased flexibility and manipulation of the suction pods with an equivalent of seven degrees' freedom of motion at the dual holder junction. Techniques for carrying out total revascularization are discussed. The progress of proportion of elective primary CABG revascularization performed off-pump is shown and results are compared with published reviews of the literature for off-pump coronary revascularization.

RESULTS

Patient demographics included: age range 32 to 87, mean 61.3; female sex: 17%; ejection fraction < 50%: 54%; presence of left main stem disease: 17%. Overall Parsonnet risk score ranged 0-31, with a mean of 8.8. Graft numbers carried out were: 34 x 2, 34 x 3, 32 x 4, 25 x 5 and 5 x 6 anastomoses respectively. The mean number of distal anastomoses was 3.6 +/- 1.0. There was extensive coverage of the lateral aspect of the heart (153 circumflex territory grafts, 33%). Radial artery, left internal mammary artery or saphenous vein sequential (jump) grafts were used in 26 cases (20%). Apart from general experience, the use of the dual holder and wide opening of the right pleura were the two important factors allowing freedom for multi-vessel lateral and posterior wall grafting. Thirteen Genzyme (Genzyme Surgical Products, Inc., Cambridge, MA) and ten Octopus 2 (or 2+) stabilizers were used, mostly for two or three grafts. The remainder were carried out using the Octopus 1 (dual holder: 83). In the first three-month period, 31% of cases were off-pump compared to the last three-month period, when 96% were off-pump. In the last two months we performed 100% of all 27 cases referred off-pump. There were no deaths, strokes or myocardial infarctions. Ventricular arrhythmia occurred in two cases. Conversions to bypass were undertaken twice. Two unexpected renal failures occurred, neither of which were from the 13 patients with preoperative incipient renal failure, of whom none suffered a rise in postoperative creatinine of greater than 30%. The results compare favorably with published results despite having a large mean number of grafts of 3.6.

CONCLUSION

Off-pump surgery with full revascularization has now become feasible for all primary elective coronary artery graft operations.

Authors+Show Affiliations

Cardiothoracic Unit, St. Mary's Hospital, Praed Street, London, United Kingdom. amit@amitroy.freeserve.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11544625

Citation

Roy, A, et al. "Progression to 100% Off-pump Coronary Artery Bypass With the Octopus 1 Dual Holder." The Heart Surgery Forum, vol. 4, no. 2, 2001, pp. 174-8.
Roy A, Stanbridge RL, O'Regan D, et al. Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. Heart Surg Forum. 2001;4(2):174-8.
Roy, A., Stanbridge, R. L., O'Regan, D., Salerno, G., Saldanha, C., Griselli, M., & Cherian, A. (2001). Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. The Heart Surgery Forum, 4(2), 174-8.
Roy A, et al. Progression to 100% Off-pump Coronary Artery Bypass With the Octopus 1 Dual Holder. Heart Surg Forum. 2001;4(2):174-8. PubMed PMID: 11544625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. AU - Roy,A, AU - Stanbridge,R L, AU - O'Regan,D, AU - Salerno,G, AU - Saldanha,C, AU - Griselli,M, AU - Cherian,A, PY - 2000/06/08/accepted PY - 2001/9/7/pubmed PY - 2001/10/12/medline PY - 2001/9/7/entrez SP - 174 EP - 8 JF - The heart surgery forum JO - Heart Surg Forum VL - 4 IS - 2 N2 - BACKGROUND: Can off-pump coronary artery bypass grafting become the routine standard in all elective primary coronary artery bypass grafting (CABG) operations? This paper shows how this aim has been achieved during one year in 130 off-pump cases performed through a sternotomy. This strategy allows for full revascularization (up to six grafts) without the disadvantage of cardiopulmonary bypass. The study introduces a variant of the Octopus stabilizer, a single Octopus 1 arm (Medtronic, Inc., Minneapolis, MN) with a dual holder. MATERIALS AND METHODS: From November 1998 through February 2000, 130 patients underwent coronary artery bypass grafting through a sternotomy off-pump utilizing a stabilizer and CO2 blower. The stabilizer most frequently used to achieve this was a single Octopus 1 arm equipped with a dual holder to accommodate two straight suction pods. The holder allowed increased flexibility and manipulation of the suction pods with an equivalent of seven degrees' freedom of motion at the dual holder junction. Techniques for carrying out total revascularization are discussed. The progress of proportion of elective primary CABG revascularization performed off-pump is shown and results are compared with published reviews of the literature for off-pump coronary revascularization. RESULTS: Patient demographics included: age range 32 to 87, mean 61.3; female sex: 17%; ejection fraction < 50%: 54%; presence of left main stem disease: 17%. Overall Parsonnet risk score ranged 0-31, with a mean of 8.8. Graft numbers carried out were: 34 x 2, 34 x 3, 32 x 4, 25 x 5 and 5 x 6 anastomoses respectively. The mean number of distal anastomoses was 3.6 +/- 1.0. There was extensive coverage of the lateral aspect of the heart (153 circumflex territory grafts, 33%). Radial artery, left internal mammary artery or saphenous vein sequential (jump) grafts were used in 26 cases (20%). Apart from general experience, the use of the dual holder and wide opening of the right pleura were the two important factors allowing freedom for multi-vessel lateral and posterior wall grafting. Thirteen Genzyme (Genzyme Surgical Products, Inc., Cambridge, MA) and ten Octopus 2 (or 2+) stabilizers were used, mostly for two or three grafts. The remainder were carried out using the Octopus 1 (dual holder: 83). In the first three-month period, 31% of cases were off-pump compared to the last three-month period, when 96% were off-pump. In the last two months we performed 100% of all 27 cases referred off-pump. There were no deaths, strokes or myocardial infarctions. Ventricular arrhythmia occurred in two cases. Conversions to bypass were undertaken twice. Two unexpected renal failures occurred, neither of which were from the 13 patients with preoperative incipient renal failure, of whom none suffered a rise in postoperative creatinine of greater than 30%. The results compare favorably with published results despite having a large mean number of grafts of 3.6. CONCLUSION: Off-pump surgery with full revascularization has now become feasible for all primary elective coronary artery graft operations. SN - 1098-3511 UR - https://www.unboundmedicine.com/medline/citation/11544625/Progression_to_100_off_pump_coronary_artery_bypass_with_the_Octopus_1_dual_holder_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -