Active Perfusion of Coronary Grafts Facilitates Complex Off-Pump Coronary Artery Bypass Surgery

(#2000-3759 ... July 21, 2000)

John D. Puskas, MD, MSc, Vinod H. Thourani, MD, Jakob Vinten-Johansen, PhD and Robert A. Guyton, MD

Division of Cardiothoracic Surgery, Department of Surgery, The Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, GA 30365

ABSTRACT

Background: Hemodynamic stability during cardiac manipulation for complex, multivessel off-pump coronary artery bypass grafting (OPCAB) remains problematic.

Methods: A servo-controlled pump has been utilized to deliver warm whole blood to coronary grafts prior to construction of proximal anastomoses.

Results: This technique may avoid detrimental hemodynamic decompensation, which may accompany regional coronary ischemia during cardiac displacement. It may also allow precise infusion of supplemental additives leading to coronary vasodilatation, myocardial resuscitation, and enhancement of myocardial contractility.

Conclusion: In this report, three complex OPCAB cases are described which were successfully performed with active graft perfusion and which might not otherwise have been technically feasible by conventional OPCAB techniques.

AUTHOR/ARTICLE INFORMATION

Submitted July 18, 2000; accepted July 21, 2000.

Address correspondence and reprint request to: John D. Puskas, MD, MSc, 550 Peachtree Street, NE, Suite 7700, Crawford Long Hospital, Emory University of School of Medicine, Atlanta, GA 30365, Phone: (404) 686-2513, Fax: (404) 686-4959, Email: jpuskas@emory.edu