Hemodynamic assessment using apical suction versus pericardial retraction in beating heart surgery.

Objective: : Aim of this study was to evaluate the perioperative hemodynamic function using an apical suction device (Xpose = XS) versus standard pericardial retraction sutures (PS) during off-pump myocardial revascularization.

Methods: : Twenty-seven consecutive patients (four female) with three-vessel disease receiving off-pump myocardial revascularization were prospectively evaluated. Mean age was 70 ± 8 years and mean ejection fraction was 55 ± 18%. Pulscontour continuous cardiac output, Swan Ganz catheter, and transesophageal echo measurements were performed. All patients received left internal mammary artery (LIMA)-left anterior descending grafting first. The XS or PS technique for marginal or right coronary artery branch exposure was used and after hemodynamic recovery the same measurements were performed using the other technique, thus each patient served as an intraindividual control. Finally, the anastomosis was performed in the respective territory.

Results: : All procedures were completed as off-pump coronary artery bypass without perioperative complications. The mean confidence interval (L/min/m)/mean arterial pressure (mm Hg) was 2.8 ± 0.5/87 ± 11 after opening the pericardium and 2.4 ± 0.4/75 ± 12 during left anterior descending exposure. During lateral wall exposure, it was 1.8 ± 0.6/67 ± 12 using XS and 1.9 ± 0.6/68 ± 12 using PS (P = ns). During inferior wall exposure, it was 2.1 ± 0.4/69 ± 12 using XS and 1.9 ± 0.4/68 ± 13 using PS (P = ns). No significant differences were seen comparing other parameters (cardiac output (CO), heart rate (HR), intrathoracic blood volume index) as well.

Conclusions: : The lateral and inferior coronary arteries can be safely exposed on the beating heart with PS or XS technique. In individual patients, either XS or PS exposure yielded a better preservation of cardiac index and blood pressure compared with baseline.