CAPS--coronary-assisted perfusion system.

Abstract

For the past 35 years the use of the extracorporeal bypass circuit has been a mainstay for coronary artery bypass grafting (CABG) in cardiac surgery arena. Since John Gibbon's early design, evolution of the pump has expanded rapidly with new techniques and engineering. The cardiopulmonary bypass (CPB) circuit has allowed cardiovascular surgeons to perform complete revascularization in a motionless and bloodless field. Presently, there is a new focus on CABGs because of new engineering designs of retractors and stabilizers, robotic techniques, and the monetary issues of cost and length of stay. Surgeons at our hospital perform 70% of CABG procedures off pump. We have developed a coronary-assisted perfusion system called CAPS. This is a simple shunt system that uses existing pump hardware to deliver arterial blood to the myocardium after the completion of the distal anastomosis. Flow is regulated by monitoring a pressure-sensing display either at systemic or suprasystemic pressure. Temperature of the blood is maintained with a Vanguard BCD heat exchanger (COBE Cardiovascular Inc., Arvada, CO) with a built-in temperature probe port. This system is capable of delivering optional agents for coronary vasodilatation, myocardial resuscitation, and performance through a connection to any standard medication infusion pump. The advantages of this system are that it is safe, requires no additional perfusion hardware, cost effective, easy to setup, has a low and rapid prime, has both inflow and outflow pressure monitoring sites, has heat a exchanger with temperature monitor, and has a drug additive port for pharmacologic infusion.