Cardiopulmonary bypass (CPB) is associated with the production of inflammatory responses, which can have significant influence on prognosis. We studied the effects of leucocyte-depletion filters on inflammatory parameters and early postoperative prognosis during coronary revascularization. Twenty patients undergoing elective coronary revascularization were randomly divided into two groups. Ten patients had leucocyte-depletion filters added to the CPB circuit (treatment group) and 10 were used as control cases (control group). Expression of CD11b on neutrophils, and production of myeloperoxidase and lactoferrin, were measured in arterial samples between induction and 3 h postbypass. In addition, clinical parameters were measured during inpatient recovery. CD11b neutrophil expression, and myeloperoxidase and lactoferrin production, were found to be upregulated during CPB and then to decline to preoperative levels by the third postoperative hour. Blood transfusion requirements were reduced in the treatment group, equalling 1.5 +/- 1.2 units, compared to 2.7 +/- 1.1 units for the control group (p value = 0.034) and so were the volumes of crystalloid infused during the first 24 h postoperatively, equalling 3.9 +/- 1.21 in the treatment group and 3.3 +/- 0.71 in the control group (p value = 0.021). Overall, the application of leucocyte depletion produced an early clinical advantage, underlining the need for an improved understanding and manipulation of the inflammatory response to CPB.

Aortic valve replacement in patients with patent coronary grafts poses many challenges. Intraoperative myocardial protection remains one of the key technical issues in these redo cases. We present a case of aortic valve replacement with patent bilateral internal thoracic artery grafts, using cross-clamp fibrillation.

Minimally invasive aortic valve replacement has been established in many centres over the last decade. Although numerous modifications have been described to date, these solely involve variations of the utilized operative incision. Total miniaturized cardiopulmonary bypass (tMCPB) offers the theoretical potential of reducing even further the overall procedural "invasiveness". We describe our initial experience of an application of MCPB for aortic valve replacement through a minimal incision.