title: Perfusion-assisted direct coronary artery bypass provides early reperfusion of ischemic myocardium and facilitates complete revascularization.
abstract: BACKGROUND
  Perfusion-assisted direct coronary artery bypass (PADCAB) was developed to initiate early reperfusion of grafted coronary artery segments during off-pump operations to resolve episodes of myocardial ischemia and avoid its sequelae. This case series outlines intraoperative findings and clinical outcomes of our first year clinical experience with PADCAB.
  
  
  METHODS
  From November 1999 to November 2000, 169 PADCAB and 358 off-pump coronary artery bypass procedures were performed at the Emory University Hospitals. The decision to use PADCAB was predicated on surgeon preference. Perfusion pressure and flow, amount of intracoronary nitroglycerin, and total perfusion time and volume were recorded at the time of operation.
  
  
  RESULTS
  One off-pump coronary artery bypass patient required emergent conversion to cardiopulmonary bypass. Two PADCAB patients had ischemic ventricular arrhythmias during target vessel occlusion that resolved once active perfusion had begun. Perfusion pressure in PADCAB grafts was on average 44% higher than mean arterial pressure (p < 0.001). Nitroglycerin, infused locally by PADCAB, was used in 67 patients to resolve ischemic episodes and increase initial coronary flows. The mean number of diseased coronary territories and grafts placed was 2.8 +/- 0.5 and 3.4 +/- 0.7, respectively, in the PADCAB group, and 2.3 +/- 0.8 and 2.7 +/- 1.0, respectively, in the off-pump coronary artery bypass group (p < 0.001 for both comparisons). More PADCAB patients received lateral wall grafts than off-pump coronary artery bypass patients (83.4% vs 59.4%; p < 0.001). Hospital death and postoperative myocardial infarction were not different between groups.
  
  
  CONCLUSIONS
  PADCAB can provide suprasystemic perfusion pressures and a means to add vasoactive drugs to target coronary vessels. PADCAB provides early reperfusion of ischemic myocardium and facilitates complete revascularization of severe multivessel coronary artery disease.
authors.affiliation: The Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. william_cooper@emoryhealthcare.org
authors.forename: William A
authors.initials: WA
authors.lastname: Cooper
authors.forename: Joel S
authors.initials: JS
authors.lastname: Corvera
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Craver
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
mesh_terms: D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D005996:Nitroglycerin / Q000008:administration & dosage; D010477:Perfusion / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005996:Nitroglycerin