Related Experiment Video
Updated: Aug 9, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Perfusion-assisted direct coronary artery bypass: selective graft perfusion in off-pump cases
R A Guyton1, V H Thourani, J D Puskas
1Department of Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, Atlanta, Georgia, USA. rguyton@emory.org
Insights
Selective graft perfusion using pressure-controlled blood delivery enhances hemodynamic stability and myocardial recovery during multivessel off-pump coronary artery bypass grafting (CABG). This novel technique offers improved outcomes for patients undergoing complex cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Vascular Physiology
Background:
- Multivessel off-pump coronary artery bypass grafting (OPCAB) poses risks of hemodynamic instability, myocardial ischemia, and potential need for cardiopulmonary bypass.
- Maintaining adequate coronary perfusion pressure is critical during OPCAB to prevent adverse cardiac events.
Observation:
- A novel pressure-controlled blood delivery technique was applied in 10 patients undergoing OPCAB.
- This method allows immediate restoration of arterial blood flow to distal coronary beds post-anastomosis.
- The system utilizes a servo-controlled pump for pressure regulation and allows for supplemental infusions.
Findings:
- Selective graft perfusion successfully enhanced myocardial perfusion in all 10 patients, with an average graft flow of 98+/-8 mL/min.
- Increased perfusion pressure (27%) resulted in a significant perfusate flow increase (59%) in three patients.
- Hemodynamic stability was achieved in all patients following the initiation of selective graft perfusion.
Implications:
- Selective graft perfusion appears to facilitate multivessel OPCAB by promoting rapid graft recovery.
- The technique enhances hemodynamic stability during subsequent anastomoses, reducing the risk of complications.
- This approach offers greater flexibility in the surgical grafting sequence, potentially improving procedural efficiency and patient outcomes.
Background:
Hemodynamic instability during multivessel off-pump coronary artery bypass grafting can lead to hypotension, progressive myocardial ischemia, further hypotension, and the need for urgent cardiopulmonary bypass.
Methods:
In 10 patients undergoing off-pump coronary artery bypass grafting, a novel technique of pressure-controlled blood delivery has been used that allows the immediate restoration of arterial blood to distal coronary beds after distal coronary anastomosis. This technique utilizes a servo-controlled pump to allow delivery of blood at systemic or suprasystemic pressures, and provides the option for infusion of supplemental additives for myocardial resuscitation, myocardial vasodilation, and enhancement of myocardial performance.
Results:
Myocardial perfusion was successfully enhanced via one or two grafts in all 10 patients with an average graft flow of 98+/-8 mL/min. In 3 patients, a 27% increase in perfusion pressure led to a 59% increase in perfusate flow. All patients were hemodynamically stable after initiation of selective graft perfusion.
Conclusions:
Based on this preliminary patient series, the selective perfusion of grafted vessels seems to facilitate multivessel off-pump coronary artery bypass grafting by promoting rapid recovery of grafted segments, by enhanced hemodynamic stability during subsequent anastomoses, and by providing increased flexibility in the sequence of grafting.
