From Cellular Energy to Systemic Circulation: Molecular Perfusion

Although extracorporeal circulation techniques and cardiopulmonary bypass (CPB) are indispensable technologies in cardiovascular surgery and medicine, they induce significant cellular stress, inflammation, oxidative damage, and metabolic imbalance. The emerging concept of “molecular perfusion” redefines perfusion not merely as the maintenance of systemic circulation but as the preservation of cellular homeostasis and energy metabolism. This approach integrates molecular pathways—such as NAD⁺/Sirtuin/AMPK/PGC-1α—into the evaluation of perfusion efficacy, acknowledging that optimal oxygenation alone does not guarantee physiological cellular function. Incorporating molecular biomarkers into perfusion management can enhance the understanding of mitochondrial dynamics, redox balance, and gene expression during CPB. Furthermore, advances in omics technologies allow precision perfusion to be tailored to each patient’s molecular and metabolic profile. In conclusion, this development positions molecular medicine at the core of modern perfusion science, transforming perfusion and surgical practices from merely providing mechanical life support to an approach aimed at preserving cellular and biochemical integrity. Thus, perfusion science advances beyond managing physiological and biochemical parameters, evolving toward a scientific perspective that targets cellular function and metabolic balance. This article is a narrative conceptual review that synthesizes current knowledge without presenting original clinical or experimental data.