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Active perfusion of coronary grafts facilitates complex off-pump coronary artery bypass surgery
J D Puskas1, V H Thourani, J Vinten-Johansen
1Division of Cardiothoracic Surgery, Department of Surgery, The Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, GA 30365, USA. jpuskas@emory.edu
Insights
Active graft perfusion using a servo-controlled pump can maintain hemodynamic stability during complex multivessel off-pump coronary artery bypass grafting (OPCAB). This technique enhances myocardial function and may enable challenging surgeries.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiothoracic Surgery
Background:
- Maintaining hemodynamic stability during complex multivessel off-pump coronary artery bypass grafting (OPCAB) is a significant challenge.
- Cardiac manipulation can lead to detrimental hemodynamic decompensation and regional coronary ischemia.
Observation:
- A servo-controlled pump was used to deliver warm whole blood to coronary grafts before proximal anastomoses construction.
- This method allows for precise infusion of additives to enhance myocardial function.
Findings:
- The active graft perfusion technique successfully prevented hemodynamic decompensation in complex OPCAB cases.
- This approach supports coronary vasodilation, myocardial resuscitation, and improved myocardial contractility.
Implications:
- This technique may make complex multivessel OPCAB procedures technically feasible when they might otherwise be impossible.
- Active graft perfusion offers a potential solution for managing hemodynamic instability during challenging cardiac surgeries.
Background:
Hemodynamic stability during cardiac manipulation for complex, multivessel off-pump coronary artery bypass grafting (OPCAB) remains problematic.
Methods:
A servo-controlled pump has been utilized to deliver warm whole blood to coronary grafts prior to construction of proximal anastomoses.
Results:
This technique may avoid detrimental hemodynamic decompensation, which may accompany regional coronary ischemia during cardiac displacement. It may also allow precise infusion of supplemental additives leading to coronary vasodilatation, myocardial resuscitation, and enhancement of myocardial contractility.
Conclusion:
In this report, three complex OPCAB cases are described which were successfully performed with active graft perfusion and which might not otherwise have been technically feasible by conventional OPCAB techniques.