Minimizing the cardiopulmonary bypass saves myocardium

Objectives: The standard heart-lung-machine is deemed a major trigger of systemic inflammatory reactions potentially inducing organ failure. The strict reduction of blood-artificial-surface and blood-air contact might represent meaningful improvements of the extracorporeal technology with respect to organ preservation. In this study, we assessed the perioperative myocardial damage by using a novel minimized (MECC) and a conventional CPB system.

Methods: Sixty patients scheduled for CABG surgery were randomly assigned to either the MECC or the standard CPB system. Myocardial marker were determined by specific immunoassays 6h, 12h and 24h after CPB initiation. Results were corrected for hemodilution.

Results: Demographics, hemodynamics, the number of anastomoses, CPB and cross clamp times were comparable between the groups. MECC patients demonstrated significantly lower levels of Troponin T (ng/ml) at 6h, 12h and 24h (0.07±0.01 vs. 0.16±0.04, p<0.005; 0.12±0.03 vs. 0.28±0.08, p<0.008; 0.21±0.05 vs. 0.35±0.09, p<0.03, respectively) and CKMB (U/l) at 6h and 12h (22.5±1.5 vs. 40.6±3.3, p<0.0001; 23.3±3.4 vs. 40.8±8.0, p<0.001, respectively). CKMB at 24h tended to lower values in the MECC group but did not quite reach statistical significance.

Conclusion: The MECC system may not only provide a less invasive solution to meet the requirements during cardiac surgery but also a more organ preserving alternative to standard CPB.

Fig. Myocardial Marker