A Coronary Active Perfusion System for Off-Pump Coronary Artery Bypass: Advantage over Passive Perfusion Regarding the Physiology of the Coronary Artery

Abstract

To avoid myocardial ischemia during off-pump coronary artery bypass, we developed a coronary active perfusion system (CAPS) that perfuses arterial blood to the coronary artery at the diastolic phase of the cardiac cycle by a syringe pump system. We report herein the details and compare CAPS with a passive shunt circuit from the femoral artery (FA shunt), regarding the physiology of the coronary artery. Six pigs were used for this study. After CAPS or FA shunt perfusion was established, coronary flow and coronary pressure were measured. The coronary flows in the native coronary artery, FA shunt perfusion, and CAPS perfusion with syringe pump stroke volume settings ranging from 0.1 to 0.4 ml were 27.2+/-3.0, 4.1+/-1.5, 12.7+/-1.2, 24.8+/-1.9, 33.3+/-1.6, and 42.2+/-1.9 ml/min, respectively. Mean coronary pressures under FA shunt perfusion and CAPS perfusion with stroke settings from 0.1 to 0.4 ml were 23.7+/-4.6, 48.8+/-5.0, 61.3+/-7.5, 70.8+/-5.4, and 82.3+/-5.2 mm Hg, respectively. CAPS had an advantage over the FA shunt regarding coronary flow with safe coronary pressure. Using CAPS, an off-pump coronary artery bypass can be performed safely without myocardial ischemia.

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

“…We proved that the coronary flow was approximately equal with the native coronary flow when we set the volume/beat of SAFE‐System to 0.2 mL/beat (7). In addition, we confirmed that the systolic pressure of the coronary artery was kept at 50–80 mm Hg when we set the volume/beat of SAFE‐System to 0.1–0.4 mL/beat (7). Based on these results, we decided to set the volume/beat of SAFE‐System to 0.1, 0.2, 0.3, and 0.4 mL/beat in this experiment.…”

“…Kamiya et al. reported that the coronary flow approximately maintained the native coronary flow when the volume/beat of SAFE‐System was set at 0.2 mL/beat (7). Based on this result, Watanabe et al.…”

Total arterial revascularization with composite skeletonized gastroepiploic artery graft in off-pump coronary artery bypass grafting

“…To maintain myocardial perfusion during anastomoses, our originally developed coronary active perfusion system was used in all cases. [15][16][17] The most critical vessel-the LAD in most patients-was revascularized first to provide a backup to other areas. Distal anastomoses were performed with 8-0 polypropylene running sutures.…”

Off-Pump Coronary Artery Bypass Surgery

“…Studies examining the physiological effect of active versus passive distal coronary perfusion have shown that active distal coronary perfusion provides superior myocardial protection compared with passive perfusion. 31,32 …”