HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Vincenzo Lucchetti Gianni D. Angelini Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lucchetti, V. Articles by Angelini, G. D. Search for Related Content PubMed PubMed Citation Articles by Lucchetti, V. Articles by Angelini, G. D.

Ann Thorac Surg 1998;65:1477-1478
© 1998 The Society of Thoracic Surgeons

---

How to Do It

An Inexpensive Method of Heart Stabilization During Coronary Artery Operations Without Cardiopulmonary Bypass

^a Cardiac Surgery, Casa di Cura S Michele, Maddaloni, Caserta, Italy
^b Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

Accepted for publication November 26, 1997.

Address reprint requests to Prof Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom

	Abstract

Top Abstract Introduction Technique Comment References

 
A method of stabilization of the heart during construction of the distal anastomosis in coronary artery procedures without cardiopulmonary bypass is described. The technique exposes and immobilizes the coronary artery, allowing a precise anastomosis on the beating heart. In addition, it is simple, safe, and inexpensive.

	Introduction

Top Abstract Introduction Technique Comment References

 
Coronary artery bypass grafting without cardiopulmonary bypass has become a well-established procedure in selected patients [1, 2]. The rationale behind this method is the avoidance of the risks of extracorporeal circulation and cardiac arrest [3]. The disadvantage is the difficulty in performing a precise distal anastomosis on a beating heart. Several methods to reduce anastomotic site motion including a suction device (Octopus; Medtronic, Minneapolis, MN) [4] and a mechanical stabilizer (CTS Inc, Cupertino, CA) have been described. Although very effective, these devices often intrude on and crowd the operative field, take time to assemble, and are extremely expensive.

During the last 8 months, we have used a simple, inexpensive method of stabilization of the heart that provides excellent exposure during construction of the distal anastomosis on the left anterior descending coronary artery and its diagonal branches and high obtuse marginal branches of the circumflex artery.

	Technique

Top Abstract Introduction Technique Comment References

 
After sternotomy, the pericardium is opened and traction sutures are applied to the edge of the pericardium. The two ends of a wet cotton tape, 2 cm wide and 80 cm long, are passed through the transverse sinus under the aorta and pulmonary artery. The lower end of the tapes thus emerge in front of the left atrial appendage. A swab is then positioned behind the posterolateral aspect of the left ventricle to displace the heart medially. The top folded end of the tape is clamped to the surgical drape while the lower ends of the tape are positioned on either side of the coronary artery to be grafted and tightened by means of a heavy stitch anchored to the pericardial diaphragmatic reflection (Fig 1).

View larger version (95K): [in this window] [in a new window]   Fig 1. Technique for stabilization of the left anterior descending coronary artery using the method described.

This technique, which has now been used in approximately 200 patients, has proved particularly valuable in facilitating exposure and stabilization of the left anterior descending coronary artery and its diagonal branches and of the high obtuse marginal branches of the circumflex artery, without compromising cardiac function.

	Comment

Top Abstract Introduction Technique Comment References

 
Steady positioning of the heart, good exposure, and stabilization of the coronary artery to be grafted are essential for performing a technically precise anastomosis without cardiopulmonary bypass. The method of stabilization described here fulfills these requirements, is easy to use without assistance, does not intrude on or crowd the surgical field, and is safe and inexpensive.

	References

Top Abstract Introduction Technique Comment References

 

1. Buffolo E., Andrade J.C.S., Branco J.N.R., et al. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 1996;61:63-66.[Abstract/Free Full Text]
2. Pfister A.J., Zaki M.S., Garcia J.M., et al. Coronary artery bypass without cardiopulmonary bypass. Ann Thorac Surg 1992;54:1085-1092.[Abstract/Free Full Text]
3. Kirklin JW, Barratt-Boyes BG. Cardiac surgery; morphology, diagnostic criteria, natural history, techniques, results and indications. 2nd ed. New York: Churchill Livingstone, 1993:73, 143–7, 175–7.
4. Borst C., Jansen E.W.L., Tulleken C.A.F., et al. Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device ("Octopus"). J Am Coll Cardiol 1996;27:1356-1364.[Abstract]

This article has been cited by other articles:

				G.J. Murphy, C.S. Rogers, W.B. Lansdowne, I. Channon, H. Alwair, A. Cohen, M. Caputo, and G.D. Angelini Safety, efficacy, and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery: A randomized trial J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 20 - 28. [Abstract] [Full Text] [PDF]

				B. Perek, M. Jemielity, J. Tomczyk, E. Camacho, and W. Dyszkiewicz Deep Pericardial Stitch Enables Hemodynamically Stable Exposure of Beating Heart Asian Cardiovasc Thorac Ann, September 1, 2003; 11(3): 203 - 207. [Abstract] [Full Text]

				R. Ascione, K. Rees, K. Santo, M. H. Chamberlain, G. Marchetto, F. Taylor, and G. D. Angelini Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes Eur J Cardiothorac Surg, July 1, 2002; 22(1): 124 - 128. [Abstract] [Full Text] [PDF]

				M. H. Chamberlain, R. Ascione, B. C. Reeves, and G. D. Angelini Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study Ann. Thorac. Surg., June 1, 2002; 73(6): 1866 - 1873. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Di Mauro, M. Contini, G. Di Giammarco, M. Pano, G. Vitolla, A. Bivona, R. Carella, and S. D'Alessandro Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of the strategy on early outcome Ann. Thorac. Surg., August 1, 2001; 72(2): 456 - 462. [Abstract] [Full Text] [PDF]

				M. P. R. Watters, R. Ascione, I. G. Ryder, F. Ciulli, A. A. Pitsis, and G. D. Angelini Haemodynamic changes during beating heart coronary surgery with the 'Bristol Technique' Eur J Cardiothorac Surg, January 1, 2001; 19(1): 34 - 40. [Abstract] [Full Text] [PDF]

				R. Ascione, M. Caputo, G. Calori, C. T. Lloyd, M. J. Underwood, and G. D. Angelini Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery : A Prospective, Randomized Study Circulation, September 26, 2000; 102(13): 1530 - 1535. [Abstract] [Full Text] [PDF]

				C. T. Lloyd, R. Ascione, M. J. Underwood, F. Gardner, A. Black, and G. D. Angelini SERUM S-100 PROTEIN RELEASE AND NEUROPSYCHOLOGIC OUTCOME DURING CORONARY REVASCULARIZATION ON THE BEATING HEART: A PROSPECTIVE RANDOMIZED STUDY J. Thorac. Cardiovasc. Surg., January 1, 2000; 119(1): 148 - 154. [Abstract] [Full Text] [PDF]

				R. Ascione, C. T. Lloyd, M. J. Underwood, A. A. Lotto, A. A. Pitsis, and G. D. Angelini Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study Ann. Thorac. Surg., December 1, 1999; 68(6): 2237 - 2242. [Abstract] [Full Text] [PDF]

				R. Ascione, C. T. Lloyd, M. J. Underwood, W. J. Gomes, and G. D. Angelini On-pump versus off-pump coronary revascularization: evaluation of renal function Ann. Thorac. Surg., August 1, 1999; 68(2): 493 - 498. [Abstract] [Full Text] [PDF]

				R. Ascione, C. T. Lloyd, W. J. Gomes, M. Caputo, A. J. Bryan, and G. D. Angelini Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study Eur J Cardiothorac Surg, May 1, 1999; 15(5): 685 - 690. [Abstract] [Full Text] [PDF]

				M. B. Izzat, K. S. Khaw, W. Atassi, A. P. C. Yim, S. Wan, and M. H. El-Zufari Routine Intraoperative Angiography Improves the Early Patency of Coronary Grafts Performed on the Beating Heart Chest, April 1, 1999; 115(4): 987 - 990. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Vincenzo Lucchetti Gianni D. Angelini Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lucchetti, V. Articles by Angelini, G. D. Search for Related Content PubMed PubMed Citation Articles by Lucchetti, V. Articles by Angelini, G. D.