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while “on pump”, the patient’s BP and cardiac output are controlled by by the perfusionist and also the anesthesiologist by means of vasoactive medications and inotropes. During this time, the patient must by systemically anticoagulated with heparin to an ACT >400 to prevent clotting in the bypass circuit. Long pump times are associated with increased post-operative complications such as bleeding, myocardial stunning, and multi-system organ failure. CPB also seems to be associated with the induction of a systemic inflammatory response syndrome (SIRS). It is sometimes difficult to liberate the patient from CPB or “get him off pump.” That is, to restart the heart contracting normally. Pressors or inotropes are often used in order to aid “coming off pump.” A variety of dysrhythmias also may occur during this period including bradycardias requiring pacing. Most often, these dysrhythmias are transient and resolve.

In the past few years, more cases are being done with “beating heart” or “off pump”. The advantages of Off-pump Coronary Artery Bypass (OPCAB) are that the patient is not exposed to the possible deleterious effects of CPB.

In some operations involving the aortic root, cross-clamping and cannulation of the aorta are not feasible. In these situations the technique of Deep Hypothermic Circulatory Arrest (DHCA) may be used. The patient is systemically cooled as much as possible (usually below 28 C) and a large dose of barbiturates are given as a neuroprotective agent. The circulation is then completely arrested for a brief period of time to allow completion of the surgical anastomosis.