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John D. Crouch, M.D., Leonard H. Kleinman, M.D., Paul
H. Werner, M.D., Thomas P. Barragry, M.D., Daniel P. OHair, M.D.,
Kristine Buechler, R.N.
St. Lukes Medical Center, Milwaukee, WI, USA
Expansion of multiple vessel off pump coronary artery bypass
(OPCAB) grafting has been limited by difficulties in exposure
and hemodynamic instability. In this study, we performed OPCAB
surgery using a new vacuum assisted heart manipulator (Xpose,
Guidant Corp., Cupertino).
Twenty-six patients, 12 females and l4 males underwent OPCAB
operations using the Xpose device. Patient age ranged from 38
to 87, with a mean of 67.7. The body surface area had a range
of l.5 to 2.6 (mean l.9). Mean ejection fraction was 54.5 (range
35 to 70).
The mean number of bypass grafts was 2.8, with 65% (l7) of patients
receiving at least 3 bypass grafts. There was one conversion
because of ventricular tachycardia. Hemodynamic data (AOP, HR,
CVP) was monitored and recorded at l, 5 and 10 minute intervals
per graft.
There was no statistically significant difference in the HR and
mean AOP. There was some fluctuation in the CVP, but the mean
AOP was > 60 mmHg in all patients during the procedure. The
mean length of stay was 5.6 days. At 30 days, there was no mortality.
In conclusion, the Xpose heart manipulator allowed OPCAB multiple
vessel grafting to be completed with minimal hemodynamic effect
and improved exposure. The device will enable surgeons to perform
multiple vessel OPCAB with greater confidence and potentially
improved outcomes.
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