Minimally ischemic off-pump coronary artery bypass grafting: active perfusion-assist with nitroglycerin-supplemented blood

Controversies in the Use of Intraluminal Shunts During Off-Pump Coronary Artery Bypass Grafting Surgery

Technical advances have made the performance of multivessel off-pump coronary artery bypass feasible. Snaring and intraluminal shunts are the techniques used for vascular control. Snaring provides a bloodless surgical field, is usually well tolerated by the patient, and is supported by years of clinical experience. Intraluminal shunts aim to achieve hemostasis at the arteriotomy site and to allow antegrade flow to provide myocardial protection. There are unresolved issues regarding whether shunts have a clinical benefit, do provide adequate flow to provide myocardial protection, and whether they cause significant endothelial damage. In this article, we have reviewed the literature to lend perspective to these issues.

Portable coronary active perfusion system for off-pump coronary artery bypass grafting

PURPOSE

The present study was performed to develop a new perfusion system for off-pump coronary artery bypass grafting and to examine whether even a simple coronary perfusion system can maintain adequate blood flow delivery during anastomosis.

DESCRIPTION

The experiment was performed in two stages. In procedure 1, 3 pigs with left anterior descending artery occlusion were used to evaluate optimal perfusion flow rate and coronary artery internal pressure, and to evaluate the safety area of perfusion. In procedure 2, 6 pigs were used to validate the new portable coronary perfusion system.

EVALUATION

The optimal blood flow in the portable coronary active perfusion system was less than approximately 40 mL/min. The small, easy to use pump system (ie, the portable coronary active perfusion system) may prevent hemodynamic deterioration and ventricular arrhythmia during coronary occlusion, resulting in better maintenance of left ventricular function.

CONCLUSIONS

Even a simple pump system can achieve effective perfusion for safe anastomosis. Further studies are required to allow the clinical use of this system.