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Adult Perfusion,
Present and Future
Emad Kashmiri
KFNGH
Adult Perfusion – Present and Future
• Extracorporeal perfusion started in 1963,s
• Since that time many new medically valuable
procedures and technologies have been
developed and utilized by perfusionists.
• This dynamic field continues to develop and
improve.
• perfusion as a profession.
• Presently in developed countries, adult cardiac
surgery is predominately focused on the
treatment of coronary artery disease.
• The tremendous expansion in cardiac surgery is
closely related to the prevalence of coronary
heart disease and the ability to apply surgical
palliation with ever decreasing risk.
• Nowdays valve and Aortic surgery is not
very common and some surgeons may
only do a few cases a year.
• Treatments such as non-surgical (balloon)
valvuloplasty further limit the number of
procedures.
• In spite of programs designed to reduce the risk
factors for coronary heart disease,
•
hypertension
diet
lack in physical exercise
smoking
obesity
genetic factors.
Coronary artery surgery is literally the sole
operation that some surgeons perform in some
centers.
About 800.000 coronary bypass
procedures are presently performed
every year worldwide.
• It has been hypothesized that elimination
of the heart lung machine will improve
morbidity and mortality in these high-risk
patients (1)
• However, few studies (2) reported no
significant reduction in morbidity with their
OPCABG patients compared to standard
CABG patients. They actually included
some advantages for the standard CABG
patients
hemodynamic stability
better blood pressure regulation
technically superior anastomosis due to
bloodless and motionless environment,
temperature control
ability to perform complete myocardial
revascularization(a).
Some of the potential advantages of using
OPCABG:
the avoidance of the aortic cross clamping
earlier extubations
shorter hospital stay,
reduction in the need for blood transfusio
lower incidence of arterial fibrillation decreased
costs !!!!

OPCABG disadvantages
-The distal anastomosis - early graft occlusion due to
increased platelet deposition at the anastomosis site.
- a drop in blood pressure and cardiac output when the
heart is elevated - resulting in hemodynamic instability.
- require large volumes of intravenous fluid to maintain
adequate arterial and pulmonary blood pressure.
Trendelenburg position to augment ventricular filling
administer low dose inotropes (4,5).
It is not always possible to perform
complete
revascularization
due
to
hemodynamic instability or anatomy of the
coronary arteries.
not recommended for OPCABG (a).
intra-myocardial coronary arteries
small coronary arteries
inaccessible calcified coronary arteries
disease through the length of the vessels
with large hearts who do not tolerate manipulation
New procedures which support ventricular
function such as implanted and external
(percutaneous) LVAD’s ,
ECMO
artificial hearts, etc.
will continue to provide perfusionists with a
rich learning environment and opportunity.
• Off pump cases now and in the future will
always require the presence of a
perfusionist that is fully trained and
capable of dealing with the very
demanding emergencies that can arise
during OPCABG.
• The level of training and experience
needed for dealing with such emergencies
will insure that perfusionists will continue
to have a critical role in all adult cardiac
surgical procedures.