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Enhanced recovery after elective coronary revascularization surgery with minimal versus conventional extracorporeal
Kyriakos Anastasiadis1, Christos Asteriou, Polychronis Antonitsis
1Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece.
Objective:
A minimal extracorporeal circulation (MECC) circuit integrates the advances in cardiopulmonary bypass (CPB) technology into a single circuit and is associated with improved short-term outcome. The aim of this study was to prospectively evaluate MECC compared with conventional CPB in facilitating fast-track recovery after elective coronary revascularization procedures.
Design:
Prospective randomized study.
Setting:
All patients scheduled for elective coronary artery surgery were evaluated, excluding those considered particularly high risk for fast-track failure. The fast-track protocol included careful preoperative patient selection, a fast-track anesthetic technique based on minimal administration of fentanyl, surgery at normothermia, early postoperative extubation in the cardiac recovery unit, and admission to the cardiothoracic ward within the first 24 hours postoperatively.
Participants:
One hundred twenty patients were assigned randomly into 2 groups (60 in each group).
Interventions:
Group A included patients who were operated on using the MECC circuit, whereas patients in Group B underwent surgery on conventional CPB.
Measurements And Main Results:
Incidence of fast-track recovery was significantly higher in patients undergoing MECC (25% v 6.7%, p = 0.006). MECC also was recognized as a strong independent predictor of early recovery, with an odds ratio of 3.8 (p = 0.011). Duration of mechanical ventilation and cardiac recovery unit stay were significantly lower in patients undergoing MECC together with the need for blood transfusion, duration of inotropic support, need for an intra-aortic balloon pump, and development of postoperative atrial fibrillation and renal failure.
Conclusions:
MECC promotes successful early recovery after elective coronary revascularization procedures, even in a nondedicated cardiac intensive care unit setting.
