Conventional or minimized cardiopulmonary bypass support during coronary artery bypass grafting? – An analysis by means of perfusion and body mass index

Abstract

The use of minimized cardiopulmonary bypass support to reduce the side effects of extracorporeal circulation is still contradictorily discussed. This study compares perfusion operated by conventional (CCPB) and minimized (MCPB) cardiopulmonary bypass support during coronary artery bypass grafting (CABG). This study includes the data of 5164 patients treated at our department between 2004 and 2014. Tissue perfusion during cardiopulmonary bypass support and cardiac arrest was assessed by means of body mass index, hemodilution, blood pressure with corresponding pump flow and venous oxygen saturation, serum lactate, and serum pH. Hemodilution was more pronounced after CCPB: hemoglobin had dropped to 4.47 ± 0.142 g/dL after CCPB and to 2.77 ± 0.148 g/dL after MCPB (P = 0.0022). Despite the higher pump flow in conventional circuits (4.86–4.95 L/min vs. 4.1–4.18 L/min), mean blood pressure was higher during minimized bypass support (53 ± 10 vs. 56 ± 13 mm Hg [aortic clamping], 57 ± 9 vs. 61 ± 12 mm Hg [34°C], 55 ± 9 vs.59 ± 11 mm Hg [aortic clamp removal], P < 0.0001) at all time points. Venous oxygen saturation remained on comparable levels of >70% during both conventional and minimized cardiopulmonary bypass support. The increase in serum lactate was more pronounced after CCPB (8.98 ± 1.28 vs. 3.66 ± 1.25 mg/dL, P = 0.0079), corresponding to a decrease in serum pH to acidotic levels (7.33 ± 0.06 vs. 7.35 ± 0.06, P < 0.0001). These effects were evident in all BMI ranges. Minimized cardiopulmonary bypass support provides efficient perfusion in all BMI ranges and is thus equivalent to conventional circuits.

2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery

“…The largest retrospective series reported data from 5164 patients showing that significantly reduced hemodilution occurs during MiECC and results in relatively lower circulatory flow and significantly higher mean blood pressures and serum pH, as well as lower serum lactate levels thus better preserving the body's metabolic integrity at all body mass index (BMI) ranges. 38 Moreover, the concept of "more-physiologic" cardiac surgery was introduced by including MiECC as a fundamental component when combined with goal-directed perfusion 73 as well as advanced in-line monitoring. 39 During the last period, various MiECC components have been evaluated for defining optimal circuit characteristics.…”

Artificial Organs 2019: A year in review

“…Zdenek Provaznik et al of the University Medical Center Regensburg, Regensburg, Germany compared perfusion operated by conventional (CCPB) and minimized (MCPB) CPB support during coronary artery bypass grafting (CABG). Their included data on 5164 patients treated in their department between 2004 and 2014.…”