Coronary artery bypass graft with minimal extracorporeal circulation (original) (raw)
Related papers
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.
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.
During the last decade, minimized extracorporeal circulation (MECC) systems have shown beneficial effects to the patients over the conventional cardiopulmonary bypass (CECC) circuits. This is a prospective randomized study of 99 patients who underwent coronary artery bypass grafting (CABG) surgery, evaluating the postoperative haematological effects of these systems. Less haemodilution (p=0.001) and markedly less haemolysis (p<0.001), as well as better preservation of the coagulation system integrity (p=0.01), favouring the MECC group, was found. As a clinical result, less bank blood requirements were noted and a quicker recovery, as far as mechanical ventilation support and ICU stay are concerned, was evident with the use of MECC systems. As a conclusion, minimized extracorporeal circulation systems may attenuate the adverse effects of conventional circuits on the haematological profile of patients undergoing CABG surgery.
Perfusion
Introduction: Despite low mortality, cardiac surgery patients may experience serious life-threatening post-operative complications, often due to extracorporeal circulation and reperfusion. Miniaturised cardiopulmonary bypass (minimally invasive extracorporeal circulation) has been developed aiming to reduce the risk of post-operative complications arising with conventional extracorporeal circulation. Methods: The COMICS trial is a multi-centre, international, two-group parallel randomised controlled trial testing whether type II, III or IV minimally invasive extracorporeal circulation is effective and cost-effective compared to conventional extracorporeal circulation in patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or coronary artery bypass grafting + aortic valve replacement. Randomisation (1:1 ratio) is concealed and stratified by centre and surgical procedure. The primary outcome is a composite of 12 serious complications, object...
Cardiology Research and Practice, 2019
Objectives. The aim of this study is to compare the effects of the minimal extracorporeal circulation (MiECT) on postoperative systemic inflammatory response and the need for transfusion in patients undergoing open heart surgery with cardiopulmonary bypass.Methods. Patients were divided into two groups; Group M (n=31) included the patients operated via using the MiECT system and Group C (n=27) included the patients operated via using conventional cardiopulmonary bypass (CPB). Perioperative markers of inflammation after cardiopulmonary bypass in both groups were tested by measuring the levels via chemiluminescent immunometric assay. Blood samples were taken consecutively after anesthesia induction, 30thminute of CPB, on the 6th, 24th, and 48thhours after cardiopulmonary bypass.Results. The mean amount of priming solution was significantly lower in Group M when compared to Group C (802.60 ± 48.26 and 1603.71 ± 49.85 ml). The mean hematocrit (Hct) value taken immediately after cardiopu...
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)
Aim: Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECC TM) compared with standard open system on-pump coronary revascularization. Methods: Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC). ABPT and overall early postoperative complications were analyzed. Results: Operative mortality and morbidity were similar in both groups. ABPT in the MECC group was significantly lower than in the sECC group both intraoperatively (7.2 vs. 60.3% of patients p<0.001) and during the first five postoperative days (19.3 vs. 57.5%; p<0.001). " Skin to skin "-(214 ± 45 vs. 232 ± 45 min; p=0.012), cardiopulmonary byp...