Unexpected hemodynamic deterioration and mitral regurgitation due to a tissue stabilizer during left anterior descending coronary anastomosis in off-pump coronary artery bypass graft surgery.

We have experienced three rare cases of hemodynamic deterioration and transient mitral regurgitation (MR) induced by a suction-type tissue stabilizer during the left internal thoracic artery (LITA)-to-LAD (left anterior descending) coronary artery anastomosis. Transesophageal echocardiogram (TEE) showed new or worsening MR during the placement of a tissue stabilizer. In all three cases, the positioning of the stabilizer was difficult to secure a good surgical field, because the LAD coronary artery migrated deep into the myocardium. This anatomical variation seemed to require a stronger fixation of the stabilizer to the heart. We concluded that compression of the left ventricular (LV) wall may have possibly caused morphologic changes of the LV and the distortion of the annulus of the mitral valve. These changes are thought to have caused decreased LV filling and the MR, which led to an unexpected hemodynamic deterioration.