Perfusion technique for perfusion-assisted direct coronary artery bypass (PADCAB).

The role for the perfusionist has changed at many institutions that perform Off-Pump Coronary Artery Bypass (OPCAB). Surgeons at our hospitals have adapted a technique called Perfusion-Assisted Direct Coronary Bypass (PADCAB) (1). A simple circuit and pump have been devised for the perfusionist to deliver arterial blood to the myocardium immediately after the completion of the distal coronary anastomosis.

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

Background: Hemodynamic instability during multivessel off-pump coronary artery bypass grafting can lead to hypotension, progressive myocardial ischemia, 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 that allows the immediate restoration of arterial blood to distal coronary beds after distal coronary anastomosis. This technique utilizes a servo-controlled pump to allow delivery of blood at systemic or suprasystemic pressures, and provides the option for infusion of supplemental additives for myocardial resuscitation, myocardial vasodilation, and enhancement of myocardial performance.