title: A coronary active perfusion system for off-pump coronary artery bypass grafting in an experimental porcine model: the relationship between flow rate and myocardial function.
abstract: We developed a coronary active perfusion system (synchronized arterial flow ensuring system [SAFE-System]) to prevent myocardial ischemia during distal anastomosis in off-pump coronary artery bypass grafting (CABG). The purpose of this study was to identify the relationship between the flow rate of the SAFE-System and myocardial function. Studies were performed on pigs, which were divided into five groups: external shunt perfusion group (group A, n = 6); 0.1 mL/beat flow rate for the SAFE-System group (group B, n = 6); 0.2 mL/beat flow rate group (group C, n = 6); 0.3 mL/beat flow rate group (group D, n = 6); and 0.4 mL/beat flow rate group (group E, n = 6). Regional myocardial blood flow and left ventricular function were monitored for 30 min. The regional myocardial blood flow in group A was severely decreased (P < 0.001), and was significantly lower than in the other groups (P < 0.001). The slope of the end-systolic pressure-volume relationship, and the slope of the preload recruitable stroke work relationship in groups A, D, and E were lower than in groups B and C. As compared with the use of a passive external shunt, a coronary active perfusion system provides adequate myocardial blood flow and hemodynamics. It was possible to maintain left ventricular function when using 0.1 or 0.2 mL/beat flow rate. The use of a coronary active perfusion system appears to make the off-pump CABG procedure safer and may increase the application of off-pump bypass grafting.
authors.affiliation: First Department of Surgery, University of Toyama, Toyama, Japan. tdoi@med.u-toyama.ac.jp
authors.forename: Toshio
authors.initials: T
authors.lastname: Doi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Takuro
authors.initials: T
authors.lastname: Misaki
mesh_terms: D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D006339:Heart Rate; D023421:Models, Animal; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D012039:Regional Blood Flow; D013552:Swine; D016277:Ventricular Function, Left