Conventional versus minimally invasive extracorporeal circulation in patients undergoing cardiac surgery: protocol for a randomised controlled trial (COMICS) (original) (raw)
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Coronary artery bypass grafting (CABG) using minimal extracorporeal circulation (MECC) has been associated with an improved short-term clinical outcome compared to conventional extracorporeal circulation (CECC). The aim of this study was to evaluate the impact of MECC compared to CECC on postoperative major adverse events in high-risk patients undergoing elective coronary revascularization procedures. Two hundred patients undergoing elective CABG were randomized into two groups. In Group A (n=100), MECC was used while Group B (n=100) included patients who were operated on CECC. The incidence of postoperative major adverse events (myocardial infarction, renal failure, stroke, death) was the primary end-point of the study. MECC was associated with a 77% relative risk reduction in the incidence of major adverse events compared to CECC (p=0.004). The rate of major adverse events occurring in the highrisk patient subgroup (preoperative left ventricular ejection fraction ≤40%, age >65 years, EuroSCORE II >5) operated on with MECC was significantly lower in comparison to their CECC counterparts. Based on our results, cardiac centres should be encouraged to use MECC as the standard circuit when performing elective coronary procedures, even in a high-risk population.
Interactive CardioVascular and Thoracic Surgery, 2016
Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society was founded to create an international forum for the exchange of ideas on clinical application and research of minimal invasive extracorporeal circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations for the clinical practice. The goal of this manuscript is to promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists.
2016
7 8 Kyriakos Anastasiadis, John Murkin, Polychronis Antonitsis, Adrian Bauer, Marco 9 Ranucci, Erich Gygax, Jan Schaarschmidt, Yves Fromes, Alois Philipp, Balthasar 10 Eberle, Prakash Punjabi, Helena Argiriadou, Alexander Kadner, Hansjoerg Jenni, 11 Guenter Albrecht, Wim van Boven, Andreas Liebold, Fillip de Somer, Harald 12 Hausmann, Apostolos Deliopoulos, Aschraf El-Essawi, Valerio Mazzei, Fausto 13 Biancari, Adam Fernandez, Patrick Weerwind, Thomas Puehler, Cyril 14 Serrick, Frans Waanders, Serdar Gunaydin, Sunil Ohri, Jan Gummert, Gianni 15 Angelini , Volkmar Falk, and Thierry Carrel. 16
Minimal extracorporeal circulation: An appraisal from a private practice
SA Heart, 2019
INTRODUCTION Cardiopulmonary bypass (CPB) and cardiac arrest allow the surgeon to perform controlled anastomoses during coronary artery bypass graft surgery (CABG). However, this comes at a cost. A systemic inflammatory response is a risk for organ damage and thus mortality and morbidity. Beating heart surgery, or off-pump CABG (OPCAB), was reintroduced to attenuate this effect. Many studies demonstrated very optimistic results in favour of OPCAB compared to CABG with conventional CPB. However, not everybody is convinced by the benefits, and this was addressed in a review on whether it would be beneficial to change to OPCAB. (1) In this study, the combined prevalence of mortality, myocardial infarction, stroke and new dialysis was 4%. To improve this with even 25% would require 10 600 patients, which is impossible in the average private cardiac practice in South Africa. Many randomised controlled studies could not demonstrate clear benefits and surgeons are losing interest in the OPCAB technique. (2) This is confirmed by a review from the Cochrane Libraries. Based on the current evidence, CABG should be done with conventional CPB. (3)
ASAIO Journal, 2010
Recognition of the adverse effects of conventional extracorporeal circulation (CECC) led to the development of alternative technologies and techniques to minimize their impact while maintaining circulation during coronary artery bypass grafting (CABG). Off-pump coronary artery bypass (OPCAB) grafting has become established as one such alternative and more recently minimalized extracorporeal circulation (MECC) circuits have been developed with the aim of providing circulatory support while minimizing the interface between blood and the foreign surfaces of the circuit that initiates the associated adverse effects of CECC. Recently, some authors have suggested that MECC may be an alternative to OPCAB in patients undergoing CABG; the aim of this article is to systematically analyze and compare the impact of CABG with MECC with that of OPCAB, studying the adverse outcomes related to CECC. We performed a systematic search to identify all studies directly comparing OPCAB and MECC. Endpoints were subcategorized into four key areas of interest: length of stay (LOS), hemorrhage, cerebrovascular injury, and 30-day mortality. Random effect modeling techniques were applied to identify differences in outcomes between the two groups. Six studies fulfilled the inclusion criteria, incorporating 2,072 patients of whom 930 underwent OPCAB and 1,142 underwent revascularization supported by MECC. We found no statistically significant difference in hospital or intensive care unit (ICU) LOS, blood loss, mean number of patients transfused, neurocognitive disturbance, or 30-day mortality between the two groups but a trend toward an increased number of cerebrovascular events in the MECC group was observed. The number of studies comparing these alternative techniques for coronary revascularization is small, and there is a lack of highquality data. Currently, there seems little difference between MECC and OPCAB but larger randomized controlled trials focusing on high-risk patients are required. ASAIO Journal 2010; 56:446 -456.
Coronary artery bypass graft with minimal extracorporeal circulation
The heart surgery forum, 2003
BACKGROUND To evaluate the advantages and benefits of a minimized extracorporeal circulation system in the performance of coronary artery bypass grafts. METHODS From September 2000 to February 2003, 279 consecutive patients underwent isolated coronary artery bypass grafting with minimal extracorporeal circulation. A group of 243 patients at good risk as defined by a Euro- SCORE of 3 underwent complete bypass and blood cardioplegia, and a high-risk group of 45 patients (EuroSCORE, 6) underwent operations with partial assistance and a beating heart. In a prospective substudy analysis of thrombocyte and platelet counts, transfusion requirements, PaO2/FIO2, leukocyte count, C-reactive protein level, postoperative bleeding, intensive care unit stay, and ventilation, 40 patients from the good-risk group were matched and compared with 40 patients who underwent operations with a conventional extracorporeal system. RESULTS Revascularization was complete with a mean of 2.8 distal anastomoses ...
2009
To evaluate the clinical results of aortic valve replacement performed with a miniaturized closed circuit extracorporeal circulation (MECC) system and to compare it to standard cardiopulmonary bypass (CPB). One hundred and twenty consecutive patients undergoing isolated aortic valve replacement were randomly assigned to either a miniaturized closed circuit CPB with the maquet-cardiopulmonary MECC System᭧ (study group, ns60) or to a standard CPB (control group, ns60). Demographic characteristic and operative data were similar in the two groups. No hospital death occurred in either group and no difference in intensive care unit (ICU) stay and in-hospital stay was observed. Patients in the study group showed lower chest tube drainage (212"62 ml vs. 420"219 ml, P-0.05) and lower need for blood products (6.1% vs. 40.4%, P-0.05) than patients in the control group. Platelet count at ICU arrival was significantly higher in the study group (139"40=10 yl vs. 164"75=10 yl, Ps0.05). Peak postoperative troponin I release was significantly lower in the MECC group 9 9 (3.81"2.7 ngydl vs. 6.6"6.8 ngydl, P-0.05). In this randomized study the MECC system has demonstrated best postoperative clinical results in terms of need for transfusion, platelets consumption and myocardial damage as compared to standard CPB.
The Annals of thoracic surgery, 2016
Minimally invasive extracorporeal circulation (MECC) is predominantly used in coronary operations. Data supporting the benefits of MECC in minimally invasive valve operations are still absent. Patients undergoing either isolated minimally invasive mitral or aortic valve procedures were prospectively randomized to a minimally invasive group (MECC; n = 101) or a conventional extracorporeal circulation group (CECC; n = 99). The procedural and postoperative outcomes were compared, including the levels of inflammation factors (procalcitonin, interleukin [IL]-6, IL-8, and IL-10), tumor necrosis factor-α [TNF-α], and interferon-gamma [IFN-γ]). The demographics were comparable between the groups regarding age (MECC versus CECC, 70.5 ± 10.2 years versus 73.1 ± 8.9 years; P = 0.086), left ventricular function (59.2% ± 13.4% versus 62.1% ± 14.0%; p = 0.302), EuroSCORE (7.4% ± 7.9% versus 6.8% ± 4.0%; p = 0.256), and other comorbidities. Hospital mortality (n = 1 versus n = 3; p = 0.339) and ot...