Comparison of two stabilizer concepts for off-pump coronary artery bypass grafting

Abstract

Background. This study was designed to evaluate the efficacy of two different stabilizer concepts for off-pump coronary artery bypass grafting. Methods. Between 2000 and 2001, 100 consecutive patients who underwent off-pump coronary artery bypass grafting were randomly assigned to two stabilization systems: the Medtronic Octopus 3 (n = 50) and the Genzyme Immobilizer (n = 50). During operation, two-dimensional cardiac surface motion was assessed by intravital microscopy using orthogonal polarization spectral imaging in 20 vessels at the anterior wall. Postoperative angiography of 47 vessels revealed anastomotic quality. Results. Patient demographics were similar in both groups regarding age, sex, ejection fraction, and New York Heart Association functional class. In 7 patients the randomized Immobilizer was rejected by the surgeon for lateral or posterior wall revascularization and subsequently switched to the Octopus device. Patients received 1.8 ± 0.7 grafts in the Octopus and 1.6 ± 0.5 in the Immobilizer group ( p = not significant). Two-dimensional cardiac surface motion was significantly less using the Immobilizer (109.7 ± 32.4 μm versus 423.5 ± 129.6 μm; p < 0.001). Time required for anastomosis was significantly shorter in the Immobilizer group (11.3 ± 3.5 versus 14.9 ± 2.4 minutes; p < 0.001). Postoperative angiography showed no vessel occlusions but two anastomotic stenoses in each group. Conclusions. Both stabilizers have been shown useful for off-pump coronary artery bypass grafting. The Immobilizer system showed better epicardial immobilization of the anterior wall resulting in shorter anastomosis times. However, because the Octopus 3 handling is more flexible and allows easier access to all vessels, it is the device of choice for posterior wall revascularization in our institution.