Coronary artery bypass on the beating heart with the Octopus: a North American experience.

BACKGROUND: The practice of minimally invasive coronary artery bypass grafting remains controversial. This study outlines the results of single and multiple vessel bypass performed using the Medtronic Octopus Tissue Stabilization System and beating heart techniques. Results are compared with those of a standard cardiopulmonary bypass group. METHODS: The group included 89 patients having operations performed during a 10-month period with average follow-up of 162.3 days. Complications, length of stay, and functional status were recorded. Postoperative stress testing and angiograms were performed selectively. RESULTS: The average age was 62.3 years and the average ejection fraction was 0.65. Twenty-five percent of the patients underwent operations urgently or emergently, averaging 1.8 grafts/patient. In 83 of 89 patients operations were completed without cardiopulmonary bypass using the Octopus without mortality. Morbidities were statistically similar to a group of 369 cardiopulmonary bypass patients. Postoperative length of stay was shorter in the Octopus group (p = 0.005). CONCLUSIONS: The Octopus provided predictable, reproducible immobilization with short-term results comparable with those obtained with standard cardiopulmonary bypass.

Results of composite graft replacement for aortic root aneurysms.

From 1972 to 1980, 41 patients (aged 19 to 79) with aortic root problems have been managed surgically with a composite graft. Forty patients (97.5%) are long-term survivors who to date have had no complications related to the aortic root. This series of patients included 10 with acute dissection of the aortic root and ascending aorta. Thirty-one patients undergoing elective operations for aortic root aneurysms included three with chronic ascending aortic dissection with aortic regurgitation, three with previous operations on the aortic root, and six patients who had associated coronary artery bypass or mitral valve replacement. Follow-up to 8 years shows that patients with composite graft replacement have exhibited no early or late complications of this procedure. Two late deaths at 1 1/2 and 5 1/2 years were unrelated to the aortic root procedure. Experience seems to indicate that composite graft management of aortic root aneurysms is a most reliable and durable operation for the majority of patients with this disease.

Cardiac operation and end-stage renal disease.

From 1972-1979, 22 patients with end-stage renal disease underwent 23 cardiac operations involving the pump oxygenator. Fourteen patients had coronary artery bypasss, 2 had aortic valve replacement, 2 had mitral valve replacement (MVR), 2 had MVR with coronary artery bypass, and 2 had ascending aortic root replacement with a composite graft. One patient underwent successful reoperation for a false aneurysm of the left ventricle after MVR. There were 2 postoperative deaths, for a mortality of 9.1%. The patients undergoing coronary artery bypass had an average of 2.7 grafts and an average Functional Class improvement from New York Heart Association Class III or IV to Class I to II. Eighteen patients required preoperative and postoperative dialysis to control blood volume, potassium, and uremia. Four patients had functioning renal transplants, and 4 patients underwent subsequent successful renal transplantation. We conclude that: (1) patients who have transplants and require dialysis can be successfully managed for cardiac operation in spite of their complex associated medical problems; (2) functional and symptomatic improvement simplifies continued management of the patient needing dialysis; and (3) improvement of a cardiac disability can allow favorable renal transplantation in selected patients.