Alteration of the Traditional Extracorporeal Bypass Circuit to Accommodate Port-Access Minimally Invasive Cardiac Procedures Using Endovascular Based Cardiopulmonary Bypass

Port-Access minimally invasive cardiac surgery systems (Heartport, Inc., Redwood City, CA, U.S.A.) enable surgeons to perform many procedures including valve surgery and complete coronary artery revascularization of all surfaces of the heart through small anterior thoracotomies. The endovascular based EndoCPB (Heartport, Inc.) cardiopulmonary bypass system uses a modified extracorporeal circuit to afford the same level of myocardial protection through cardioplegic cardiac arrest and bypass as is provided in traditional open chest surgery. We describe the changes required to convert a conventional CPB pump circuit to perform Port-Access procedures and make recommendations based on clinical experience to facilitate establishing a Port-Access surgical team and interpreting EndoCPB pressure and flow data. Specific emphasis is placed on the expanded role of the perfusionist in these cases.