Thorac Cardiovasc Surg 2008; 56(2): 65-70
DOI: 10.1055/s-2007-989336
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Is There Really a Clinical Benefit of Using Minimized Extracorporeal Circulation for Coronary Artery Bypass Grafting?

J. Schöttler1 , G. Lutter1 , A. Böning1 , D. Soltau1 , B. Bein2 , D. Caliebe2 , N. Haake1 , F. Schoeneich1 , J. Cremer1
  • 1Department of Cardiovascular Surgery, School of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • 2Department of Anesthesiology, School of Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
Further Information

Publication History

received July 30, 2007

Publication Date:
18 February 2008 (online)

Abstract

Background: Minimized extracorporeal circulation is intended to reduce the negative effects associated with cardiopulmonary bypass. This prospective study was performed to evaluate whether minimized extracorporeal circulation has a clinical benefit for coronary artery surgery patients compared to standard extracorporeal circulation. Methods: Sixty patients were randomized into two study groups: 30 patients underwent coronary artery bypass grafting using minimized extracorporeal circulation and 30 patients were operated using standard extracorporeal circulation. Baseline characteristics, intraoperative details, postoperative data, perioperative blood chemistry determinations of hematocrit, platelets, muscle-brain fraction of the creatine kinase, cardiac troponin T and colloid osmotic pressure as measurements of intrathoracic blood volume index and extravascular lung water index were compared. Results: Baseline characteristics and intraoperative details of both groups were similar. Patients who underwent minimized extracorporeal circulation showed more short-term dependency on norepinephrine (p < 0.01). Their maximal postoperative muscle-brain fraction of the creatine kinase was lower (p < 0.05) and their hematocrit on arrival in the intensive care unit was higher (p < 0.01). No other significant differences were found. In both collectives, values for hematocrit (p < 0.001), platelets (p < 0.001), colloid osmotic pressure (p < 0.001) and intrathoracic blood volume index (p < 0.05) decreased, while the extravascular lung water index did not change significantly during cardiopulmonary bypass. Conclusions: A clinical advantage of minimized over standard extracorporeal circulation was not found. Furthermore, a higher number of patients in the minimized extracorporeal circulation group required postoperative norepinephrine infusions for hemodynamic stabilization. In summary, the presumed superiority of minimized extracorporeal circulation for coronary artery bypass grafting in standard patients could not be confirmed.

References

  • 1 Takai H, Eishi K, Yamachika S, Hazama S, Ariyoshi T, Nishi K. Demonstration and operative influence of low prime volume closed pump.  Asian Cardiovasc Thorac Ann. 2005;  13 65-69
  • 2 Wippermann J, Albes J M, Hartrumpf M. et al . Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system.  Eur J Cardio Thorac Surg. 2005;  28 127-132
  • 3 Fromes Y, Gaillard D, Ponzio O. et al . Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation.  Eur J Cardio Thorac Surg. 2002;  22 527-533
  • 4 Van Boven W J, Gerritsen W B, Waanders F G, Haas F J, Aarts L P. Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and biochemical results.  Perfusion. 2004;  19 239-246
  • 5 Wiesenack C, Liebold A, Philipp A. et al . Four years' experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome.  Artificial Organs. 2004;  28 1082-1088
  • 6 Abdel-Rahman U, Özaslan F, Risteski P S. et al . Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit?.  Ann Thorac Surg. 2005;  80 238-243
  • 7 Khan N E, De Souza A, Mister R. et al . A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery.  N Engl J Med. 2004;  350 21-28
  • 8 Widimsky P, Straka Z, Stros P. et al . One-year coronary bypass graft patency.  Circulation. 2004;  110 3418-3423
  • 9 Cremer J, Martin M, Redl H. et al . Systemic inflammatory response syndrome after cardiac operations.  Ann Thorac Surg. 1996;  61 1714-1720
  • 10 Raja S G, Dreyfus G D. Modulation of systemic inflammatory response after cardiac surgery.  Asian Cardiovasc Thorac Ann. 2005;  13 382-395
  • 11 Immer F F, Pirovino C, Gygax E, Englberger L, Tevaearai H, Carrel T P. Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery.  Eur J Cardio Thorac Surg. 2005;  28 701-704
  • 12 Liebold A, Khosravi A, Westphal B. et al . Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization.  J Thorac Cardiovasc Surg. 2006;  131 268-276
  • 13 Bein B, Caliebe D, Scholz J, Steinfath M, Tonner P H, Boening A. A new cardiopulmonary bypass circuit with reduced foreign surface (CorX™): initial clinical experience and implications for anaesthesia management.  Eur J Anaesthesiol. 2004;  21 982-984
  • 14 Salukhe T V, Wyncoll D L. Volumetric haemodynamic monitoring and continous pulse contour analysis - an untapped resource for coronary and high dependency care units?.  Br J Cardiol. 2002;  9 20-25
  • 15 Beghi C, Nicolini F, Agostinelli A. et al . Mini-cardiopulmonary bypass system: results of a prospective randomized study.  Ann Thorac Surg. 2006;  81 1396-1400
  • 16 Bical O M, Fromes Y, Gaillard D. et al . Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery.  Eur J Cardio Thorac Surg. 2006;  29 699-702
  • 17 Remadi J P, Marticho P, Butoi I. et al . Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution?.  Ann Thorac Surg. 2004;  77 2172-2176
  • 18 Remadi J P, Rakotoarivello Z, Marticho P. et al . Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial.  J Thorac Cardiovasc Surg. 2004;  128 436-441
  • 19 Palombo D, Valenti D, Gaggiano A, Lupo M, Borin P. Early experience with the minimal extracorporeal circulation system (MECC®) during thoracoabdominal aortic aneurysm repair.  Eur J Vasc Endovasc Surg. 2004;  27 324-326

Dr. Jan Schöttler

Department of Cardiovascular Surgery
School of Medicine
University of Schleswig-Holstein
Campus Kiel

Arnold-Heller-Straße 7

24105 Kiel

Germany

Email: cjschoettler@arcor.de