International Society For Minimally Invasive Cardiothoracic Surgery

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Development Of A Heart Positioner For Mics Cabg: Tentacles Neo
Tomohiro Mizuno, Tatsuki Fujiwara, Hidehito Kuroki, Hirokuni Arai.
Tokyo Medical and Dental University, Graduate School of Medical and Dental Science, Tokyo, Japan.

Background: Minimally invasive coronary artery bypass grafting (MICS CABG) via a small left thoracotomy is becoming popular in the last several years; however, commercially available heart positioner devices for MICS CABG are not developed yet.
Methods: Our department developed a multi-arm flexible heart positioner, called "Tentacles NEO". This device has three flexible arms with a suction cup at each tip similar to the present "Tentacles," which was previously developed in our department for off-pump CABG. The new suction cup measures 41 (length) x 17 (width) x 17 (height) mm (the current device: 43 x 22 x 21 mm). A suction tube and a traction cord are attached transversely at the center of the cup in two of three suction cups and vertically in one of three suction cups. The suction tubes and traction cords can be detached from the device body; therefore, they can be pulled out toward any direction from a small hole around the small thoracotomy. We measured the adsorption force of the suction cup, checked the design and concept for a small thoracotomy in a pig model, and used it in off-pump CABG via median full sternotomy to confirm whether the adsorption force is strong enough or not.
Results: Although the sideways adsorption force of the new suction cup is as strong as that of the present device, the longitudinal and perpendicular adsorption force of the new device is approximately 80% that of the present device because of the smaller suction cup. However, the new device could safely and favorably displace the heart and expose the left anterior descending artery, left circumflex artery and posterior descending artery via a small thoracotomy in a pig model and even in off-pump CABG. The suction tubes and traction cords were pulled out from small holes around the thoracotomy; hence, they did not disturb the operative field and working space of a small thoracotomy.
Conclusions: The new heart positioner "Tentacles NEO" will function effectively in MICS CABG.


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