Perfusion-assisted direct coronary artery bypass: Selective graft perfusion in off-pump cases

Background. Hemodynamic instability during multivessel off-pump coronary ar tery bypass grafting can lead to hypotension, progressive myocardial ischem ia, further hypotension, and the need for urgent cardiopulmonary bypass. Methods. In 10 patients undergoing off-pump coronary artery bypass grafting , a novel technique of pressure-controlled blood delivery has been used tha t allows the immediate restoration of arterial blood to distal coronary bed s after distal coronary anastomosis. This technique utilizes a servo-contro lled pump to allow delivery of blood at systemic or suprasystemic pressures , and provides the option for infusion of supplemental additives for myocar dial resuscitation, myocardial vasodilation, and enhancement of myocardial performance. Results. Myocardial perfusion was successfully enhanced via one or two graf ts in all 10 patients with an average graft now of 98 +/- 8 mL/min. In 3 pa tients, a 27% increase in perfusion pressure led to a 59% increase in perfu sate flow. All patients were hemodynamically stable after initiation of sel ective graft perfusion. Conclusions. Based on this preliminary patient series, the selective perfus ion of grafted vessels seems to facilitate multivessel off-pump coronary ar tery bypass grafting by promoting rapid recovery of grafted segments, by en hanced hemodynamic stability during subsequent anastomoses, and by providin g increased flexibility in the sequence of grafting. (C) 2000 by The Societ y of Thoracic Surgeons.