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J Thorac Cardiovasc Surg 1998;116:60-67
© 1998 Mosby, Inc.

Surgery For Adult Cardiovascular Disease

Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients

Erik W. L. Jansen, MDa, Cornelius Borst, MD, PhDc, Jaap R. Lahpor, MD, PhDa, Paul F. Gründeman, MD, PhDc, Frank D. Eefting, MDc, Arno Nierich, MDb, Etienne O. Robles de Medina, MD, PhDc, Johan J. Bredée, MD, PhDa

The study was supported by a grant from The Netherlands Heart Foundation (No. 1993/43.028) and the University Hospital, Utrecht (No. 1995/B903).

Received for publication Nov. 24, 1997. Revisions requested Jan. 15, 1998; revisions received Feb. 13, 1998. Accepted for publication Feb. 13, 1998. Address for reprints: Erik W. L. Jansen, MD, Heart-Lung Institute, Utrecht University Hospital (Room E03.406), P.O. Box 85500, 3508, GA Utrecht, The Netherlands.

Objective: Cardiopulmonary bypass and global cardiac arrest enable safe coronary artery bypass grafting but have adverse effects. In off-pump coronary bypass grafting, invasiveness is reduced, but anastomosis suturing is jeopardized by cardiac motion. Therefore the key to successful off-pump coronary bypass grafting is effective local cardiac wall stabilization.
Methods: We prospectively assessed the safety and efficacy of the Octopus tissue stabilizer (Medtronic, Inc., Minneapolis, Minn.) in the first 100 patients selected for off-pump coronary bypass via full or limited surgical access. To immobilize and expose the coronary artery, two suction paddles (–400 mm Hg), fixed to the operating table-rail by an articulating arm, stabilized the anastomosis site.
Results: One hundred forty-one grafts (96% arterial) were used to create 172 anastomoses (17% side-to-side), up to 4 per patient, on average 2.3 in the full access group (46 patients) and 1.2 in the limited access group (54 patients). Complications included conversion to cardiopulmonary bypass (2%), conversion from limited to full access (3%), myocardial infarction (4%), predischarge coronary reintervention (2%), and late coronary reintervention (1%). Median postoperative length of hospital stay was 4 days (limited access) or 5 days (full access). Rapid recovery allowed 96% of patients to resume social activities within 1 month. At the 6-month angiographic follow-up, 95% of anastomoses was patent. At the 2- to 22-month follow-up (mean, 13 months), 98 patients were in Canadian Cardiovascular Society class I and 2 patients were in class II.
Conclusion: These results suggest that off-pump coronary artery bypass grafting with the Octopus tissue stabilizer is safe. Early clinical outcome and patency rates warrant a randomized study comparing this methods with conventional coronary bypass grafting.




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