Skip to main content

Advertisement

SpringerLink
Log in

Koronarchirurgie am schlagenden Herzen während mechanischer Linksherzassistenz (SUPPCAB)

Coronary surgery on a beating heart during mechanical left cardiac assist device support (SUPPCAB)

  • Themenschwerpunkt: Minimal Invasive Herzchirurgie
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: In der Koronarchirurgie gibt es 2 Ansatzpunkte zur Reduktion der Invasivität: 1. den chirurgischen Zugang und 2. die Herz-Lungen-Maschine (HLM).

Methodik: Bei 116 Patienten führten wir zwischen 1. Oktober 1994 und 30. April 1997 eine Koronarrevaskularisation am schlagenden Herzen mit mechanischer Linksherzunterstützung (LVAD; left ventricular assist device) durch. Es wurden der linke Vorhof und die Aorta ascendens kanüliert, als Assist-System wurde eine Zentrifugalpumpe eingesetzt. Wir wählten den Routinezugang der medianen Sternotomie. Während der mechanischen Entlastung erhielten die Patienten Esmolol® zur Reduktion der Herzarbeit.

Ergebnisse: Die Patienten wurden retrospektiv in 3 Gruppen unterteilt (bezüglich Auswurffraktion [EF; left ventricular ejection fraction] oder Dringlichkeit). Die erwartete Operationsletalität (eOL) wurde nach dem Parsonnet-Score errechnet.

Gruppe I (EF>35%): n=70, Operationsletalität (OL): 4,3% (3), eOL: 9 ± 8%.

Gruppe II (EF ≤ 35%): n=29, OL=6,9% (2), eOL: 10 ± 6%.

Gruppe III (Infarkt innerhalb der präoperativen Woche und/oder Notfalloperation): n=17, OL=23,5% (4), eOL: 27 ± 18%.

Wir führten 176 Anastomosen am schlagenden Herzen durch, das bedeutet im Durchschnitt 1,5 ± 0,6 Anastomosen pro Patient.

Schlußfolgerungen: In unserer Sicht ist diese Methode des aortokoronaren Bypasses am schlagenden Herzen unter LVAD-Schutz eine sichere Methode für die Revaskularisation der Vorderseitenwand und des RCA-Gebietes (right coronary artery).

Summary

Background: In coronary surgery there exist 2 possible ways to approach reduction of invasiveness: 1) surgical access, and 2) heart lung machine (HLM).

Methods: Between October 1st, 1994 and April 30th, 1997, we performed coronary surgery in 116 patients on a beating heart under LVAD (left ventricular assist device) support. After routine midline sternotomy, left atrium and ascending aorta were cannulated and centrifugal pumps were employed for mechanical circulatory assistance. During LVAD support we administered Esmolol® for reduction of cardiac work.

Results: Retrospectively we divided the patients into 3 groups according to ejection fraction (EF) and urge of operation. The predicted perioperative mortality (ppm) was calculated according to the Parsonnet score.

Group I (EF>35%): n=70, perioperative mortality (pom): 4.3% (n=3), ppm: 9 ± 8%.

Group II (EF ≤ 35%): n=29, pom=6.9% (n=2), ppm: 10 ± 6%.

Group III (infarction within the preoperative week and/or emergency operation): n=17, pom=23.5% (n=4), ppm: 27 ± 18%.

We performed 176 anastomoses on a beating heart, which means an average of 1.5 ± 0.6 distal anastomoses per patient.

Conclusions: In our view, coronary artery bypass grafting during LVAD support without heart lung machine and cardioplegia is a safe procedure for revascularization of the anterior and lateral wall as well as the right coronary artery area.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arom KV, Emery RW, Nicoloff DM: Mini-sternotomy for coronary artery bypass grafting. Ann Thorac Surg 1996;61:1271–1272.

    Article  Google Scholar 

  2. Benetti FJ: Coronary artery bypass without extracorporeal circulation versus percutaneous transluminal coronary angioplasty: Comparison of costs. J Thorac Cardiovasc Surg 1991;102:802–803.

    CAS  PubMed  Google Scholar 

  3. Benetti FJ, Naselli G, Wood M, Geffner L: Direct myocardial revascularization without extracorporeal circulation. Chest 1991;100:312–316.

    Article  CAS  PubMed  Google Scholar 

  4. Borst C, Jansen EWL, Tulleken CAF, Gründeman PF, Mansvelt Beck HJ, van Dongen JWF, Hodde KC, Bredée JJ: 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.

    Article  Google Scholar 

  5. Buffolo E, Andrade JCS, Branco JNR, Aguiar LF, Ribeiro EE, Jatene AD: Myocardial revascularization without extracorporeal circulation. Seven-year experience in 593 cases. Eur J Cardio-thorac Surg 1990;4:504–508.

    Article  CAS  Google Scholar 

  6. Casimir-Ahn H, Lönn U, Peterzén B: Clinical use of the Hemopump cardiac assist system for circulatory support. Ann Thorac Surg 1995;59:S39-S45.

    Article  CAS  PubMed  Google Scholar 

  7. Hartz RS: Minimally invasive heart surgery. Circulation 1996;94:2669–2670.

    Article  Google Scholar 

  8. Landreneau RJ, Mack MJ, Magovern JA, Acuff TA, Benckart DH, Sakert TA, Fetterman LS, Griffith BP: „Keyhole” coronary artery bypass surgery. Ann Surg 1996;224:453–462.

    Article  Google Scholar 

  9. Parsonnet V, Dean D, Bernstein AD: A method for uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989;79 (suppl I): I3-I12.

    CAS  PubMed  Google Scholar 

  10. Pfister AJ, Zaki MS, Garcia JM, Mispireta LA, Corso PJ, Qazi AG, Boyce SW, Coughlin TR jr, Gurny P: Coronary artery bypass without cardiopulmonary bypass. Ann Thorac Surg 1992;54:1085–1092.

    Article  CAS  PubMed  Google Scholar 

  11. Reichenspurner H, Gulielmos V, Daniel WG, Schüler S: Minimal invasive coronary-artery bypass surgery. New Engl J Med 1997;336:67–68.

    Article  CAS  PubMed  Google Scholar 

  12. Shennib H, Lee AGL, Akin J: Safe and effective method of stabilization for coronary artery bypass grafting on the beating heart. Ann Thorac Surg 1997;63:988–992.

    Article  CAS  PubMed  Google Scholar 

  13. Stevens JH, Burdon TA, Peters WS, Siegel LC, Pompili MF, Vierra MA, St. Goar FG, Ribakove GH, Mitchell RS, Reitz BA: Port-access coronary artery bypass grafting: A proposed surgical method. J Thorac Cardiovasc Surg 1996;111:567–573.

    Article  Google Scholar 

  14. Sweeney MS, Frazier OH: Device-supported myocardial revascularization: Safe help for sick hearts. Ann Thor Surg 1992;54:1065–1070.

    Article  CAS  Google Scholar 

  15. Waldenberger FR, Hotz H, Haisjackl M, Konertz W: Chirurgische Revaskularisation am schlagenden Herzen. Z Kardiol 1996;85 (suppl 4): 35–41.

    Google Scholar 

  16. Waldenberger FR, Wouters P, deRuyter E, Flameng W: Mechanical unloading with a miniaturized axial flow pump (Hemopump): An experimental study. Artificial Organs 1995;19:742–746.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aus der Universitätsklinik und Poliklinik für Herzchirurgie, Germany

    F. R. Waldenberger, M. Lengsfeld, S. Holinski &  W. Konertz

  2. Universitätsklinik für Anästhesiologie des Universitätsklinikums Charité der Humboldt-Universität zu Berlin, Deutschland

    M. Haisjackl

Authors
  1. F. R. Waldenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Haisjackl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Lengsfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Holinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Konertz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Konertz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waldenberger, F.R., Haisjackl, M., Lengsfeld, M. et al. Koronarchirurgie am schlagenden Herzen während mechanischer Linksherzassistenz (SUPPCAB). Acta Chir Austriaca 30, 16–19 (1998). https://doi.org/10.1007/BF02619843

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02619843

Search

Navigation