Perfusion-assisted direct coronary artery bypass: selective graft perfusion in off-pump cases.
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.
Guyton
R A
RA
Department of Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, Atlanta, Georgia, USA. rguyton@emory.org
Thourani
V H
VH
Puskas
J D
JD
Shanewise
J S
JS
Steele
M A
MA
Palmer-Steele
C L
CL
Vinten-Johansen
J
J
D000368:Aged; D000714:Anastomosis, Surgical; D001794:Blood Pressure / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery; D005112:Extracorporeal Circulation / Q000295:instrumentation; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007387:Internal Mammary-Coronary Artery Anastomosis; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000209:etiology; D010477:Perfusion / Q000295:instrumentation; D017534:Radial Artery / Q000637:transplantation; D012501:Saphenous Vein / Q000637:transplantation; D014665:Vasodilator Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D014665:Vasodilator Agents