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Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients
Assad Haneya1, Alois Philipp, Christof Schmid
1Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. assadhaneya@web.de
Insights
Minimised extracorporeal circulation (MECC) is a safe alternative for coronary artery bypass grafting (CABG) surgery. MECC offers lower 30-day mortality, reduced transfusion needs, and less organ damage, particularly beneficial for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Patient Outcomes
Background:
- Coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC) is standard for revascularization.
- Minimised extracorporeal circulation system (MECC) is emerging as a potentially safer alternative for multi-vessel CABG.
Purpose of the Study:
- To compare the safety and efficacy of MECC versus conventional ECC in high-risk CABG patients.
- To evaluate clinical course and serological/hematological parameters between MECC and ECC groups.
Main Methods:
- Retrospective analysis of 244 high-risk CABG patients (logistic EuroScore >10%) between 2004-2007.
- Patients were divided into ECC (n=139) and MECC (n=105) groups; demographic data were comparable.
- Clinical outcomes and laboratory parameters were compared between the two groups.
Main Results:
- MECC group had significantly shorter ECC time (96 vs. 120 min).
- MECC was associated with lower creatinine kinase levels 6 hours post-surgery and reduced red blood cell transfusion requirements.
- 30-day mortality was significantly lower in the MECC group (12.4%) compared to the ECC group (26.6%).
Conclusions:
- MECC is a safe and effective alternative for CABG surgery, especially in high-risk individuals.
- MECC systems demonstrate advantages including reduced 30-day mortality, lower transfusion needs, and less myocardial and renal damage.
- The findings support increased adoption of MECC in cardiac surgical procedures.
Background:
Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard for surgical coronary re-vascularisation. Recently, minimised extracorporeal circulation system (MECC) has been postulated a safe and advantageous alternative for multi-vessel CABG.
Method:
Between January 2004 and December 2007, 244 high-risk patients (logistic EuroScore (ES)>10%) underwent CABG in our institution. ECC was used in 139 (57%) and MECC in 105 (43%) patients. Demographic data including age (MECC: 73.4+/-7.4 years; ECC: 73.3+/-6.4 years), ES (MECC: 19.2+/-9.8%; ECC: 21.4+/-11.9%), left-ventricular ejection fraction (MECC: 45.6+/-16.1%; ECC: 43.1+/-15.3%), diabetes mellitus (MECC: 14.3%; ECC: 15.1%) and COPD (MECC: 6.7%; ECC: 7.9%) did not differ between the two groups. Preoperative end-stage renal failure was an exclusion criterion. The clinical course and serological/haematological parameters in the ECC and MECC patients were compared in a retrospective manner.
Results:
Although the numbers of distal anastomoses did not differ between the two groups (MECC: 3.0+/-0.9; ECC: 2.9+/-0.9), ECC time was significantly shorter in the MECC group (MECC: 96+/-33 min; ECC: 120+/-50 min, p<0.01). Creatinine kinase (CK) levels were significantly lower 6 h after surgery in the MECC group (MECC: 681+/-1505 U l(-1); ECC: 1086+/-1338 U l(-1), p<0.05) and the need of red blood cell transfusion was significantly less after MECC surgery (MECC: 3 [range: 1-6]; ECC: 5 [range: 2-9] p<0.05). Moreover, 30-day mortality was significantly lower in the MECC group as compared to the ECC group (MECC: 12.4%; ECC: 26.6, p<0.01).
Discussion:
MECC is a safe alternative for CABG surgery. A lower 30-day mortality, lower transfusion requirements and less renal and myocardial damage encourage the use of MECC systems, especially in high-risk patients.
