Aim of the study : To evaluate our initial results in beating heart CABG performed in patients with multivessel disease, using the Octopus™ tissue stabiliser.
Methods : Forty patients (mean age 65.5 years, range 39-83) underwent beating heart CABG by median sternotomy with the use of Octopus™ 1 (n 27) and Octopus™ 2 (n 13) devices.
Twenty pts had unstable angina, 4 pts had pulmonary edema, and 3 pts required preoperative intra-aortic balloon counterpulsation. Five procedures were redos. Mean ejection fraction was 45.4 % (range 20-82). Eighteen pts had triple-vessel disease, 18 pts had double-vessel disease and > 50 % left main stem stenosis was present in 6 (isolated or in association). The hospital mortality risk for the study population computed preoperatively according to the Society for Thoracic Surgeons risk stratification averaged 3.6 % (range 0.3-29.2).
Results : The average number of distal anastomoses was 2.5 (range 1-5, total number 101); a mean of 1.5 (range 1-3) anastomoses was realised with arterial grafts (45 mammary and 12 gastroepiploic arteries). Shunt insertion was necessary in 2 cases. Endarterectomies were performed in 3 pts. Extracorporeal circulation support was required in 5 pts to achieve hemodynamic stability. A thorough dual beam Doppler flowmeter evaluation was performed intraoperatively in each graft.
Six distal anastomoses had to be redone because of an occlusion pattern at Doppler flowmeter evaluation and in one case because of a disrupted gastroepiploic artery anastomosis. The 6.9% incidence of anastomotic failure is significantly higher than the 1.6% incidence observed in our previous experience with CABG realised under cardiac arrest (p = 0.002, odds ratio = 4.7). However, all these failed anastomoses could be redone successfully and normal flowmetry was demonstrated by the end. The administration of dobutamine at an inotropic concentration > 5 g.Kg-1.min-1.was required in only 1 pt.
Thirty-day hospital mortality was 2.5 % (one patient died on POD 26) and the perioperative myocardial infarction rate was 0%. Transient episodes of supraventricular arrhythmias were detected in 19 pts.
Conclusions : Good results can be achieved with beating heart CABG surgery, particularly in high-risk pts with three-vessel disease. However, despite the use of very efficient tissue stabilisers, the hazard of anastomotic failure is significantly increased. Immediate graft patency assessment by any available method is thus mandatory.