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Platelet preservation in cardiac surgery using minimally invasive extracorporeal circulation versus optimized
Brian Beairsto1, Cyril Serrick1, Amanda Fernandez1
1Department of Perfusion, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
Background:
Minimally invasive extracorporeal circulation (MiECC) is employed as a strategy to attenuate the physiologic disturbance caused by cardiopulmonary bypass. The aim of this study was to compare the coagulation profile of MiECC to an optimized conventional extracorporeal circuit (OpECC) with regards to platelet function, rotational thromboelastometry and blood product usage.
Methods:
A retrospective analysis of coronary artery bypass grafting operations using either MiECC or OpECC was performed at a single institution.
Results:
A total of 112 patients were included, with 61 receiving MiECC and 51 OpECC patients. OpECC patients had a significantly larger BSA (1.95+/- 0.22m2 vs 1.88 +/- 0.18m2, p = 0.034), than those who received MiECC. No difference between groups was observed regarding red blood cell, plasma, and platelet transfusions. Functional platelet count during the warming phase of cardiopulmonary bypass was found to be higher in the MiECC group ((136 (102-171) x109/L vs 109 (94-136) x109/L), p = 0.027), as were functional platelets as a percent of total platelet count ((86 (77-91)% vs 76 (63-82)%), p = 0.003). There were no significant differences between other outcomes such as operative mortality, incidence of stroke, and intensive care unit length of stay.
Conclusion:
While we did not see a difference in blood transfusions, MiECC resulted in a statistically significant advantage over OpECC with regards to preservation of functional platelets.
Insights
Minimally invasive extracorporeal circulation (MiECC) better preserves platelet function compared to optimized conventional extracorporeal circulation (OpECC). This study found MiECC maintained higher functional platelet counts during cardiopulmonary bypass without increasing blood product use.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Hematology
Background:
- Cardiopulmonary bypass (CPB) can cause significant physiological disturbances.
- Minimally invasive extracorporeal circulation (MiECC) is a strategy to mitigate these effects.
- Optimized conventional extracorporeal circulation (OpECC) serves as a benchmark for comparison.
Purpose of the Study:
- To compare the coagulation profile of MiECC versus OpECC.
- To evaluate differences in platelet function and blood product usage between MiECC and OpECC.
- To assess the impact of MiECC on key clinical outcomes.
Main Methods:
- Retrospective analysis of coronary artery bypass grafting (CABG) operations.
- Inclusion of 112 patients: 61 in the MiECC group and 51 in the OpECC group.
- Comparison of coagulation profiles, platelet function assays, and blood product transfusion data.
Main Results:
- No significant differences in red blood cell, plasma, or platelet transfusions between groups.
- MiECC group showed higher functional platelet counts (136 vs 109 x10^9/L, p=0.027) during CPB.
- MiECC group demonstrated a higher percentage of functional platelets (86% vs 76%, p=0.003).
- No significant differences in operative mortality, stroke incidence, or ICU length of stay.
Conclusions:
- MiECC offers a statistically significant advantage in preserving functional platelets compared to OpECC.
- Despite no difference in blood transfusions, MiECC demonstrates superior platelet function preservation.
- MiECC may be a beneficial alternative for mitigating CPB-associated hemostatic disturbances.
