Use of apical suction to facilitate extra-anatomic bypass for recurrent coarctation: a case report
© Kuduvalli et al; licensee BioMed Central Ltd. 2006
Received: 26 January 2006
Accepted: 28 March 2006
Published: 28 March 2006
The use of apical suction devices has been well described for maintaining satisfactory haemodynamics during off-pump surgical coronary revascularization. Its expanded use has been described in a few other situations. We describe here a case of recurrent coarctation where an extra-anatomic ascending to descending thoracic aorta bypass graft was constructed using cardiopulmonary bypass without arresting the heart, and access and exposure were facilitated by the use of an apical suction device.
In view of his symptomatic status, a re-intervention was considered appropriate. In view of his previous surgery, and especially the fact that the area of re-coarctation appeared to be calcified, it was decided to approach the aorta via a median sternotomy and construct an extra-anatomic ascending to descending thoracic aorta bypass graft. Cardiopulmonary bypass would be necessary to lift the heart out of the way to gain access to the descending thoracic aorta just above the diaphragm. We planned to use an apical suction device to keep the empty beating heart elevated.
The use of apical suction devices for cardiac positioning in off pump coronary artery surgery, and its ability to maintain good beating heart dynamics has been described [1, 2]. Apart from being used in off-pump coronary artery bypass grafting, the apical suction device has been described to have expanded uses in a variety of scenarios. It has been described for use in pericardectomies, during lysis of adhesions in redo coronary surgery, for securing epicardial haemostasis in penetrating cardiac trauma, for securing haemostasis during re-exploration after cardiac surgery and for facilitating epicardial microwave ablation .
Its use has also been described in a case of recurrent coarctation in which an ascending-to-abdominal aorta bypass graft was successfully facilitated by the use of an apical suction device . The operation was done without the use of cardiopulmonary bypass.
In the case described in our report, the use of cardiopulmonary bypass was necessary because the heart would probably not have tolerated the amount of elevation which would have been required to expose the descending thoracic aorta just above the diaphragm, which was our target area for constructing the anastomosis. However, our rationale for use of the apical suction device on the empty beating heart was: 1) to avoid cross clamping the heart for a prolonged period of time for an extra-cardiac operation 2) to make the elevation and retraction of the empty beating heart technically easier, and less traumatic on the epicardium and myocardium compared to retracting and elevating with the use of the assistant's hand. We could accomplish both these objectives safely and successfully, with adequate exposure to clamp the descending thoracic aorta and perform the anastomosis.
This report describes another expanded use for the apical suction device.
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