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Updated: Jul 26, 2026
Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism
Published on: January 12, 2019
[Utility of the perfusion-assist for beating heart coronary artery bypass surgery]
S Muraki1, M Tsukamoto, K Komatsu
1Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Insights
Off-pump coronary artery bypass surgery can cause myocardial injury. A modified direct coronary artery bypass system with perfusion effectively prevented myocardial damage and hemodynamic instability in 10 patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioprotection
Background:
- Off-pump coronary artery bypass (OPCAB) surgery carries a risk of myocardial injury due to temporary vessel occlusion.
- Maintaining hemodynamic stability during complex anastomoses is crucial for patient outcomes.
Observation:
- A novel technique, modified perfusion-assisted direct coronary artery bypass (PADCAB), was employed in 10 patients undergoing OPCAB.
- This system allowed for active coronary perfusion of the target vessel throughout the grafting procedure.
- Nitroglycerin was administered directly into the coronary arteries via the perfusion system.
Findings:
- Perfusion averaged 2,072.8 ml over 92.9 minutes at 120 mmHg.
- No instances of hemodynamic instability were observed, even during challenging anastomoses.
- No detectable myocardial damage, assessed by echocardiography and troponin-T levels, occurred perioperatively.
Implications:
- The modified PADCAB system demonstrates significant potential for myocardial protection during OPCAB surgery.
- This technique may reduce the risk of ischemia and improve safety in complex coronary artery bypass grafting.
- Further research could validate these findings in larger patient cohorts and diverse surgical scenarios.
Abstract:
During off-pump coronary artery bypass surgery, concern remains about the possible myocardial injury associated with the transient occlusion and stabilization of the target vessels. To try to minimize myocardial ischemia and achieve hemodynamic stability, we utilized a coronary perfusion catheter combined with the perfusion-assisted direct coronary artery bypass system that enables active and modified coronary perfusion of the target vessel throughout the duration of multiple grafting (modified PADCAB). In the series of 10 patients, perfusion of the target coronary systems averaged 2,072.8 +/- 649.7 ml over 92.9 +/- 26.1 minutes under a constant infusion pressure of 120 mmHg. Nitroglycerin (100 micrograms/l of flow) was delivered directly into the coronary arteries as an additive in all patients. Hemodynamic instability was notably absent in all cases, even in cases that required difficult anastomosis with a relatively long time for the anastomosis. There were no perioperative complications and no detectable myocardial damage (i.e., impairment of myocardial wall motion indicated by echocardiography findings or by > 0.25 ng/ml of troponin-T release compared to the preoperative level) in this series of patients.
