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In Reply: In response to Mr Patel, we discussed the conduct of perfusion in considerable detail in the preliminary report from this study,¹ which was cited extensively in our current article. We do agree, however, that cardiopulmonary bypass techniques and technologies have recently been the subject of significant innovation, perhaps as a response to the perceived "threat" of off-pump CABG. Low-prime circuits, retrograde autologous priming, coated tubing, and dilutional ultrafiltration have recently demonstrated promise and are techniques and technologies we and others currently use. However, during enrollment for our trial, mini-primed circuits were in an early phase of development. Perfusion techniques in our trial were state of the art at the time and were compared with contemporary techniques for off-pump CABG.

Techniques and technologies for off-pump CABG have also improved since we began our trial. New suction-based cardiac positioning devices and improved coronary stabilizers now provide improved visualization and stabilization . . . [Full Text of this Article]

John D. Puskas, MD, MSc
john_puskas@emoryhealthcare.org
Department of Surgery (Cardiothoracic)

Candace Palmer-Steele, CCP
Perfusion Services
Emory Crawford Long Hospital
Emory University School of Medicine
Atlanta, Ga

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