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International Society For Minimally Invasive Cardiothoracic Surgery

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A 13-year Experience Of Tentacles
Eiki Nagaoka, Hirokuni Arai, Tomohiro Mizuno, Keiji Oi, Tatsuki Fujiwara, Kiyotoshi Oishi.
Tokyo Medical and Dental University, Tokyo, Japan.

BACKGROUND: Off-pump coronary artery bypass grafting (CABG) reduces the risks related to cardiopulmonary bypass. However, sufficient target vessel exposure is sometimes difficult in off-pump CABG. Incomplete revascularization and low-quality anastomosis from suboptimal exposure are associated with higher incidence of repeat revascularization and increased mortality. Emergent conversion from hemodynamic instability is associated with worse outcomes. The objective of this study is to evaluate safety and efficacy of Tentacles heart positioner system in a 13-year of non-selective all off pump CABG cases.
METHODS: We developed the Tentacles heart positioner, which consists of 3 independent flexible suction cups. Each of the suction cup attached to heart surface can be pulled by an elastic silicone cord which enable the heart to keep physiological beating. Since 2007 to 2019, a total of 522 patients have undergone isolated CABG in our institution. Of these, 457 patients (94 women, mean age 69.1  9.0 years), for whom off-pump CABG was intended at the beginning of procedure, were included in this study. Tentacles was used in all cases. Short and long-term outcomes were analyzed retrospectively.
RESULTS: There were 77 (17%) urgent/emergent CABG. Excellent target vessel exposure for all coronary territories could be provided with the Tentacles. The mean number of grafts per patient was 3.7  1.1. Complete revascularization was achieved in all patients. However, seven patients (1.5%) required conversion to on-pump beating CABG. The reasons of conversion were hypotension in 3 patients and critical arrhythmia in 4 patients. The 30-day mortality rate was 0%. There was one (0.2%) in-hospital death from sepsis following pneumonia in a 76-year-old chronic hemodialysis patient. One (0.2%) patient experienced stroke in early postoperative period. During the long-term follow-up, 17 patients (3.7%) required percutaneous coronary intervention but there was no redo CABG. Freedom from all cause death was 98%, 92% and 82% at 1, 5 and 10 years, respectively. Freedom from major adverse cardiovascular or cerebrovascular events (MACCE) was 92%, 78% and 62%.
CONCLUSIONS: Coronary artery bypass grafting using Tentacles heart positioner resulted in satisfactory short-term outcomes. The long-term outcomes were also excellent with low incidence of death, MACCE and repeat revascularization.

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