Myocardial protection for off-pump coronary artery bypass surgery.
Myocardial protection during off-pump coronary artery bypass surgery (OPCAB) is a multifactorial problem. Careful, individualized choice of graft sequence and maintenance of stable systemic hemodynamics are of central importance. Recently refined techniques for atraumatic rotation of the heart and visualization of coronary anastomoses allow precise and controlled grafting of all coronary territories without cardiopulmonary bypass in the large majority of cases. Perfusion-assisted direct coronary artery bypass (PADCAB) techniques, in which coronary perfusion pressure is independent of systemic arterial pressure, can avoid or abort a downward hemodynamic spiral, which may occasionally occur during complex, multivessel OPCAB. PADCAB promotes collateral myocardial perfusion and avoids the cumulative global effect of sequential episodes of regional ischemia, improving myocardial protection during OPCAB.
Puskas
J D
JD
Division of Cardiothoracic Surgery, Department of Surgery, Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, GA 30365, USA.
Vinten-Johansen
J
J
Muraki
S
S
Guyton
R A
RA
D000714:Anastomosis, Surgical; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D006801:Humans; D015425:Myocardial Reperfusion; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D013536:Suture Techniques