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Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience
Thomas Puehler1, Assad Haneya, Alois Philipp
1Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. thomas.puehler@klinik.uni-regensburg.de
Insights
Minimal extracorporeal circulation (MECC) offers a safe alternative to standard extracorporeal circulation (ECC) for coronary artery bypass grafting (CABG). This 10-year study shows MECC is associated with low mortality and transfusion rates in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Coronary artery bypass grafting (CABG) is standard for multivessel coronary artery disease.
- Standard extracorporeal circulation (ECC) can cause side effects.
- Minimal extracorporeal circulation (MECC) was developed to reduce ECC-associated complications.
Purpose of the Study:
- To report on a 10-year experience with MECC for coronary revascularization.
- To analyze patient data, clinical course, and perioperative outcomes.
- To assess mortality risk factors in the MECC group.
Main Methods:
- Retrospective observational study of 2243 patients undergoing CABG with MECC (January 1998 - August 2009).
- Analysis of indication, preoperative co-morbidity, postoperative course, and perioperative outcome.
- Assessment of risk factors for mortality.
Main Results:
- Mean logistic EuroSCORE was 4.5%. Mean age was 66.8 years.
- Overall 30-day mortality was 2.3%, significantly lower than standard ECC.
- Low rates of intra-operative transfusion (15.3%), catecholamine support, hemodialysis, stroke, and delirium were observed.
Conclusions:
- MECC is an established alternative to ECC for routine CABG.
- MECC use is linked to low mortality and conversion rates.
- Excellent survival rates and reduced perioperative transfusion needs were achieved with MECC.
Objective:
Coronary artery bypass grafting (CABG) is the gold standard for the surgical therapy of multivessel coronary artery disease. To reduce the side effects, associated with standard extracorporeal circulation (ECC), a concept of minimal extracorporeal circulation (MECC) was devised in our center. We report on our 10-year experience with the MECC for coronary revascularization.
Methods:
From January 1998 to August 2009, 2243 patients underwent CABG with MECC in our center. In a retrospective observational study, we analyzed indication, preoperative patient co-morbidity, postoperative clinical course, and perioperative outcome of all patients operated on with MECC. Furthermore, the risk factors for mortality in the MECC group were assessed.
Results:
Patients showed a mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 4.5±0.1%. The mean age of the patients was 66.8±9.1 years. The overall 30-day mortality after CABG with MECC was 2.3%, ranging from 1.1% for elective to 13.0% for emergent patients and was significantly better than standard ECC. Only 15.3% (n=344) of patients with MECC required intra-operative blood transfusion. Postoperative catecholamine support, red blood cell transfusion, need for hemodialysis, release of creatinine kinase, incidence of stroke, and postoperative delirium were low after MECC revascularization. Ejection fraction below 30% (odds ratio (OR): 5.1), emergent operation (OR: 9.4), and high-dose catecholamine therapy (OR: 2.6) were associated predictors for mortality.
Conclusion:
MECC until now is an established concept and has become an alternative for ECC in routine CABG in our center. The use of the MECC system is associated with low mortality and conversion rate. Excellent survival rates and low transfusion requirements in the perioperative course were achieved.
