Perfusion
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Coronary artery bypass (CABG) surgery with cardiopulmonary bypass (CPB) has been the "gold standard" for many years. However, methods to conduct off-pump coronary artery bypass (OPCAB) surgery with a beating heart have decreased the use of CPB. Improvements in cardiopulmonary bypass technology, using low-prime circuits with retrograde autologous prime, have demonstrated a reduction in blood use while maintaining the surgical advantage of increased revascularization associated with on-pump surgery. ⋯ Based on the decision-analysis model, a relatively low major event rate (defined as myocardial infarction, need for angioplasty or surgery) at 4 years of 2% can eliminate the savings associated with OPCAB when compared to a low-prime circuit with RAP. Using a 5% major event rate at 4 years, the predicted cost savings of LP/RAP over OPCAB is $510 per patient or $51,036,746 per 100,000 patients. The development and implementation of low-prime circuits with retrograde autologous prime is an import step in matching the outcomes associated with OPCAB surgery.