Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures

Abstract

During the last decade, minimized extracorporeal circulation (MECC) systems have shown beneficial effects to the patients over the conventional cardiopulmonary bypass (CECC) circuits. This is a prospective randomized study of 99 patients who underwent coronary artery bypass grafting (CABG) surgery, evaluating the postoperative haematological effects of these systems. Less haemodilution (p=0.001) and markedly less haemolysis (p<0.001), as well as better preservation of the coagulation system integrity (p=0.01), favouring the MECC group, was found. As a clinical result, less bank blood requirements were noted and a quicker recovery, as far as mechanical ventilation support and ICU stay are concerned, was evident with the use of MECC systems. As a conclusion, minimized extracorporeal circulation systems may attenuate the adverse effects of conventional circuits on the haematological profile of patients undergoing CABG surgery.

Keywords

MECC system extracorporeal circulation bypass grafting blood coronary artery disease

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References

Laffey JG , Boylan JF , Cheng DC The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002; 97: 215-252.

Moat NE , Shore DF , Evans TW Organ dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteins. Eur J Cardiothorac Surg 1993; 7: 563-573.

Puehler T. , Haneya A. , Philipp A. , et al. Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization. Ann Thorac Surg 2009; 87: 766-772.

Schönberger JP , Everts PA , Hoffmann JJ Systemic blood activation with open and closed venous reservoirs. Ann Thorac Surg 1995 ; 59: 1549-1555.

Andersen KS , Nygreen EL , Grong K. , Leirvaag B. , Holmsen H. Comparison of the centrifugal and roller pump in elective coronary artery bypass surgery - a prospective, randomized study with special emphasis upon platelet activation. Scand Cardiovasc J 2003 ; 37: 356-362.

Wendel HP , Ziemer G. Coating-techniques to improve the hemocompatibility of artificial devices used for extracorporeal circulation. Eur J Cardiothorac Surg 1999; 16: 342-350.

Moen O. , Fosse E. , Dregelid E. , et al. Centrifugal pump and heparin coating improves cardiopulmonary bypass biocompatibility. Ann Thorac Surg 1996 ; 62: 1134-1140.

Shigeta O. , Kojima H. , Hiramatsu Y. , et al. Low-dose protamine based on heparin-protamine titration method reduces platelet dysfunction after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1999; 118: 354-360.

Hansbro SD , Sharpe DA , Catchpole R. , et al. Haemolysis during cardiopulmonary bypass: an in vivo comparison of standard roller pumps, non-occlusive roller pumps and centrifugal pumps . Perfusion 1999; 14: 3-10.

10.

de Haan J. , Boonstra PW , Monnink SH , Ebels T. , van Oeveren W. Retransfusion of suctioned blood during cardiopulmonary bypass impairs hemostasis . Ann Thorac Surg 1995; 59: 901-907.

11.

Albes JM , Stöhr IM , Kaluza M. , et al. Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and coating. J Thorac Cardiovasc Surg 2003; 126: 1504-1512.

12.

Takai H. , Eishi K. , Yamachika S. , et al. The efficacy of low prime volume completely closed cardiopulmonary bypass in coronary artery revascularization. Ann Thorac Cardiovasc Surg 2004; 10: 178-182.

13.

Srinivas K. , Singh K. Combination of autologous transfusion and retrograde autologous priming decreases blood requirements. Ann Card Anaesth 2001; 4: 28-32.

14.

Habib RH , Zacharias A. , Schwann TA , Riordan CJ , Durham SJ , Shah A.

Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?

J Thorac Cardiovasc Surg 2003; 125: 1438-1450

15.

Huybregts RA , Morariu AM , Rakhorst G. , et al. Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg 2007; 83: 1760-1766.

16.

Haneya A. , Philipp A. , Diez C. , et al. Comparison of two different minimized extracorporeal circulation systems: hematological effects after coronary surgery. ASAIO J 2009; 55: 592-597.

17.

Immer F. , Pirovino C. , Gygax E. , Englberger L. , Tevaearai H. , Carrel TP Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg 2005; 28: 701-704.

18.

Remadi JP , 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.