Combined coronary artery bypass grafting and aortic valve replacement with minimal extracorporeal closed circuit circulation versus standard cardiopulmonary bypass

Abstract

Isolated aortic valve replacement (AVR) or coronary artery bypass grafting (CABG) using minimized extracorporeal circulation (MECC) has been shown to have less deleterious effects than standard cardiopulmonary bypass (CPB). In this prospective cohort study, we evaluated and compared clinical results of combined AVR with CABG using MECC. We prospectively collected preoperative, intraoperative, postoperative and follow-up data of 65 patients who underwent combined AVR with CABG using MECC and compared these with 135 patients undergoing combined AVR with CABG using standard CPB. No significant differences were seen in patients demographic characteristics or intraoperative data. Patients in the MECC group experienced a smaller preoperative haemoglobin drop (4.5±0.8 g/dl vs. 5.0±0.5 g/dl, P=0.002) resulting in higher haemoglobin at discharge (11.3±1.3 g/dl vs. 10.8±1.1 g/dl, P=0.03). They had decreased blood products requirements (P=0.004) compared to patients in the standard CPB group. No differences were noted in pulmonary complications, neurological events or mortality. We present for the first time data showing that combined AVR with CABG using MECC is feasible and provides better clinical results compared to standard CPB with regard to blood products requirements, without compromising operative morbidity or mortality.

The “benefits” of the mini-extracorporeal circulation in the minimal invasive cardiac surgery era

“…MECC procedures have some significant differences compared with CCPB. It is a completely closed-volume system due to the lack of the venous reservoir which has been removed [2,5,7,19]. In a mini circuit, the reservoir is the patient himself, so venous return indicates cardiac output [21].…”

“…More than a third of the patients experience undesired effects due to coronary artery bypass grafting (CABG) [6]. CCPB can induce an inflammatory response and activate the coagulation process [2,7], which in combination with organ dysfunction leads to arrhythmias, neurological disorders, prolonged bleeding, or thromboembolism [8,9]. Hemodilution and transfusion of blood products reinforce the detrimental effects of CCPB [10].…”

“…The final result is less end-organ damage, including the myocardium and the lungs [14,15]. Thus, MECC has been successfully applied in CABG as well as in some cases of aortic valve replacement (AVR) [7,[16][17][18].…”

Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery

“…These findings have led to an increasing interest in expanding the use of MCPB systems in more complex cardiac surgery. MCPB circuits have been used in aortic valve replacement (AVR) surgery, where this technique has already been associated with reduced need for red blood cell transfusions, better preserved platelet count and reduced myocardial damage compared to CCPB 13,16 .…”

Inflammatory response and extracorporeal circulation

“…A similar effect of MECC on inflammatory cytokines was observed in patients undergoing aortic valve replacement [61]. These results are promising, but pulmonary complications, neurologic events or mortality were not significantly reduced due to usage of MECC [62]. Despite improvements regarding haemodilution and blood transfusion requirements, MECCs still contain a considerable potential to trigger an SIRS [63].…”