Minimal Extracorporeal Circulation is a Promising Technique for Coronary Artery Bypass Grafting

• Published in: The Annals of thoracic surgery Vol. 84; no. 5; pp. 1515 - 1521
• Main Authors: Immer, Franz F., MD, Ackermann, Andreas, MD, Gygax, Erich, EBCP, Stalder, Mario, MD, Englberger, Lars, MD, Eckstein, Friedrich S., MD, Tevaearai, Hendrik T., MD, Schmidli, Juerg, MD, Carrel, Thierry P., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-11-2007
• Subjects: Adult; Aged; Atrial Fibrillation - etiology; Cardiopulmonary Bypass; Cardiothoracic Surgery; Complement Membrane Attack Complex; Complement System Proteins - analysis; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Extracorporeal Circulation - adverse effects; Extracorporeal Circulation - methods; Female; Humans; Interleukin-6 - blood; Male; Middle Aged; Postoperative Complications - etiology; Prospective Studies; Surgery; 25
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.05.069

Background Minimal extracorporeal circulation (MECC) is a promising perfusion technology, taking the advantage of an ECC while having a significantly reduced priming volume. We analyzed the actual possible benefits of using MECC in patients undergoing CABG procedures and compared the results with conventional extracorporeal circulation (CECC). Methods One thousand fifty-three consecutive patients underwent CABG surgery using the MECC perfusion technique. Subgroup analyses focused on perioperative myocardial markers (cardiac troponin I [cTnI]), incidence of atrial fibrillation (AF), and perioperative evaluation of inflammatory markers and data were compared with those of patients who underwent CABG using CECC. A propensity score analysis was performed. Results Patient characteristics and distribution of EuroSCORE risk were similar in both groups. Severity of coronary artery disease and extent of revascularization were also comparable in both groups (number of distal anastomoses: 3.2 ± 1.1 in CECC vs 3.2 ± 0.9 in MECC; p = not significant [ns]). The cTnI was significantly lower in the MECC group (11.0 ± 10.8 μg/L in MECC vs 24.7 ± 25.3 μg/L in CECC; p < 0.05). Incidence of AF was 11.1% in MECC and 39.0% in CECC ( p < 0.05). Inflammatory markers (interleukin-6, SC5b-9) were lower in MECC patients ( p < 0.05). Propensity score analysis confirmed faster recovery in MECC patients and lower incidence of AF. Conclusions Minimal extracorporeal circulation is a safe perfusion technique for CABG and may therefore concurrence OPCAB and traditional CABG under CECC.