Effect of octopus tissue stabilizer on cardiac output during off-pump coronary artery bypass graft surgery

Introduction
Significant hemodynamic derangements can occur during off-pump coronary artery bypass graft (OPCAB) surgery resulting from the displacement of the beating heart, which may necessitate conversion to on-pump surgery.

Aim
We proposed to evaluate the alterations in hemodynamic parameters in patients during the course of anastomosis in OPCAB surgery using the Octopus tissue stabilizer.

Material and methods
In 100 consecutive patients undergoing OPCAB surgery, hemodynamic variables including cardiac output (CO), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were recorded at baseline, during each coronary artery anastomosis at 2 min, 10 min and after release of the Octopus tissue stabilizer.

Results
CO decreased significantly after target stabilization and during all coronary anastomoses (5.42 ±1.1 l/min at baseline, 4.26 ±1.02 l/min at 2 min and 3.92 ±0.98 l/min at 10 min; p < 0.001), with the greatest decrease noted during obtuse marginal (OM) branch of left circumflex artery anastomosis (3.67 ±0.86 l/min at 2 min and 3.38 ±0.78 l/min at 10 min). Inotropic drugs were required to maintain mean arterial pressure (MAP) > 60 mm Hg in 43 patients, which was most frequently noted during OM anastomosis (p < 0.001). The incidence of bradycardia requiring inotropes was noted to be the highest during left anterior descending (LAD) artery anastomosis (p = 0.002).

Conclusions
During OPCAB surgery using the Octopus for coronary target stabilization, CO decreased the most during OM anastomosis requiring inotropes, while bradycardia was most frequent during LAD anastomosis. Careful monitoring and management of hemodynamic variables are therefore of utmost importance to avoid conversion to on-pump surgery.