Objective: To review our results with the use of miniaturized cardiopulmonary bypass (Mini-CPB) versus conventional cardiopulmonary bypass (C-CPB) in high-risk patients (additive EuroSCORE≥6) who have undergone coronary artery bypass graft surgery (CABG).
Patients and methods: This study includes a consecutive series of 236 patients with an additive EuroSCORE≥6 who underwent CABG, employing either C-CPB or Mini-CPB. Propensity score analysis was performed.
Results: The study groups had similar EuroSCOREs. Stroke rate was significantly higher among C-CPB patients (5.4% vs. 0%, p=0.026). In-hospital mortality (4.8% vs. 3.4%, p=0.75) and combined adverse end-point rate were higher in C-CPB patients (20.4% vs. 13.5%, p=0.18). Postoperative bleeding and need for transfusion were similar in the study groups, but re-sternotomy for bleeding was more frequent among C-CPB patients (4.8% vs. 1.1%, p=0.26). Seventy-four propensity matched pairs had similar immediate postoperative results: C-CPB patients had higher mortality (6.8% vs. 4.1%, p=0.72), stroke (5.4% vs. 0%, p=0.12) and combined adverse end-point rates (27.0% vs. 16.2%, p=0.11), but such differences failed to reach statistical significance.
Conclusions: Mini-CPB achieved somewhat better results than C-CPB in these high-risk patients undergoing isolated CABG. This study confirmed that cerebral protection could be the main benefit associated with the use of Mini-CPB.
Pillai JB, Suri RMCoronary artery surgery and extracorporeal circulation: the search for a new standard. J Cardiothorac Vasc Anesth2008; 22: 594-610.
2.
Nissinen J., Biancari F., Wistbacka JO, et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion2009; 24: 297-305.
3.
Paparella D. , Yau TM, Young E.Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg2002; 21: 232-244.
4.
Remadi JP, Rakotoarivelo Z., Marticho P., Benamar A.Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J2006; 151: 198.
5.
Abdel-Rahman U., Ozaslan F., Risteski PS, et al. Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit?Ann Thorac Surg2005; 80: 238-243.
6.
Fromes Y., Gaillard D., Ponzio O., et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg2002; 22: 527-533.
7.
Huybregts RA , Morariu AM, Rakhorst G., et al. Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg2007; 83: 1760-1766.
8.
Kamiya H., Kofidis T., Haverich A., Klima U.Preliminary experience with the mini-extracorporeal circulation system (Medtronic resting heart system). Interact Cardiovasc Thorac Surg2006; 5: 680-682.
9.
Schöttler J., Lutter G., Böning A., et al. Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting?Thorac Cardiovasc Surg2008; 56: 65-70.
10.
Remadi JP, Rakotoarivelo 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 Surg2004; 128: 436-441.
11.
Wippermann J. , Albes JM, 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 Cardiothorac Surg2005; 28: 127-132.
12.
Skrabal CA, Choi YH, Kaminski A., et al. Circulating endothelial cells demonstrate an attenuation of endothelial damage by minimizing the extracorporeal circulation. J Thorac Cardiovasc Surg2006; 132: 291-296.
13.
Ohata T., Mitsuno M., Yamamura M., et al. Minimal cardiopulmonary bypass attenuates neutrophil activation and cytokine release in coronary artery bypass grafting. J Artif Organs2007; 10: 92-95.
14.
Biancari F. , Rimpiläinen R.Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart2009 ; 95: 964-969.
15.
Lahtinen J. , Biancari F., Rimpiläinen J., et al.Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE≥6) . Thorac Cardiovasc Surg2007; 55: 13-18.
16.
Bridgewater B.Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement. BMJ2005; 330: 506-510.
17.
Nashef SA, Roques F., Michel P., Gauducheau E., Lemeshow S., Salamon R.European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg1999; 16: 9-13.
18.
Higgins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L.Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity score. JAMA1992; 267: 2344-2348.
19.
Barbut D., Hinton RB, Szatrowski TP, et al. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke1994; 25: 2398-2402.
20.
Liebold A., Khosravi A., Westphal B., et al. Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg2006; 131: 268-276.
21.
Perthel M., El-Ayoubi L., Bendisch A., Laas J., Gerigk M.Clinical advantages of using mini-bypass systems in terms of blood product use, postoperative bleeding and air entrainment: an in vivo clinical perspective . Eur J Cardiothorac Surg2007; 31: 1070-1075.
22.
Rimpiläinen R.Impact of miniaturized cardiopulmonary bypass system on cerebral embolization in patients undergoing coronary artery bypass surgery. Operatiiviset päivät, Abstract, Helsinki, 2009.
