Right heart circulatory support facilities coronary artery bypass without cardiopulmonary bypass.

Abstract

Revascularization of the posterior wall often causes hemodynamic instability in beating heart coronary artery bypass (CAB). Our previous clinical studies have shown that tilting the heart primarily alters right-heart hemodynamics. The purpose of this study was to evaluate right-heart support in clinical cases. Seventeen patients underwent beating heart CAB with right-heart support. The right-heart support system (A-Med Systems, West Sacramento, CA) consisted of a coaxial cannula placed through the right atrium and the tip of the cannula positioned in main pulmonary artery. Blood was removed from the right atrium and returned to the main pulmonary artery. Elective beating heart CAB was accomplished successfully in 17 patients with right-heart support. Anastomoses performed were left anterior descending coronary artery (11), diagonal (3), circumflex (5), obtuse marginal artery (11), and right coronary artery (10). Right-heart support between 1 and 3 L/min improved hemodynamics especially in the circumflex position. No device-related patient incidents occurred, nor were there incidents of infection or air embolism. All 17 patients were discharged to their homes. The right-heart support system was safe without complications. Exposure of the posterior wall was possible in all cases without hemodynamic compromise.