Complex open heart surgery with minimal extracorporeal circulation

Objective: Systems for Minimal extracorporeal circulation (MECC) are known to reduce the systemic trauma of cardiopulmonary bypass (CPB). Since the routine use of MECC is limited to closed procedures and isolated aortic valve replacements are already reported, here we describe a complex case of aortic- and mitral-valve surgery with a modified MECC-system.

Methods: A 72 years old male patient with aortic stenosis grad 3 and mitral valve regurgitation grad 2–3 was scheduled for surgery. The softline-coated MECC-system was modified for open heart surgery with perpetuation of all safety criteria as there are: venous bubble trap for de-airing and pulmonary artery venting directly re-routed into the MECC-circuit. To further minimize the priming volume, retrograde arterial priming of CPB was used. The procedure was recorded by video camera in the operating room.

Results: Aortic valve replacement with stentless bioprosthesis and mitral valve ring-anuloplasty was performed without elongation of the standardized procedure (OP-Duration: 201minutes; CPB: 130 minutes; aortic cross clamping: 80 minutes). The main circulatory parameter during CBP and the left-ventricular unloading were perfect without the need for additional left-ventricular venting. Weaning from CBP was uncomplicated. The lactate level during CPB was <1.2mmol/l the hematocrite >33%. No blood transfusion was nessesary. Cardiac enzymes and troponin were not elevated postoperatively (Troponin-T 1.1ng/ml; CK: 180U/l, CK-MB: 25.9U/l). Time of mechanical-ventilation was 6h. No neurologic or systemic complication was detected.

Conclusion: Closed MECC-CPB-system is useful for complex open heart surgery. The clinical benefit as reported in CABG surgery has to be shown in clinical studies.