Extracorporeal Circulation, Optimized: A Pilot Study

Abstract

We designed a pilot study to assess as primary end point the safety and efficacy of a new phosphorylcholine-coated, closed cardiopulmonary bypass (CPB) system (extracorporeal circulation, optimized [ECC.O], Dideco, Mirandola, Italy). The secondary end point was to compare results with two retrospectively matched cohorts of patients who underwent isolated coronary artery by-pass graft (CAGB) with nonphosphorylcholine-bonded circuits and cardiotomy suction (Group II, n = 32) and off-pump coronary artery by-pass (OPCAB) (Group III, n = 26). In January 2005, 30 patients (Group I) undergoing first-time CABG were assigned to the ECC.O group. Five minutes after CPB, initial hematocrit levels were significantly and consistently highest in Group I relative to Group II (Group I, 29.7 +/- 4.4 vs. Group II, 22.7 +/- 4.1; P < 0.001). Red blood cell transfusion rate was reduced drastically in Group I versus Group II (P < 0.001). High differences were also observed in C-reactive protein levels at 24 h after surgery (Group I vs. Group II-P < 0.001 and vs. Group III-P < 0.001) and at 72-h peak value (Group I vs. Group II-P < 0.001 and vs. Group III-P < 0.001). The routine clinical use of the ECC.O system has been demonstrated to be both clinically safe and efficacious. An intensive training program for surgeons, perfusionists, and anesthesiologists is required.

Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit

“…To reduce the amount of transfused RBCs in cardiac surgery there are many techniques and approaches, one of them is reducing the priming volume with an intended result of diminishing hemodilution. 1,2,11,13,14 This must affect the hematocrit values during CPB and reduce or obviate the need for transfusion of RBCs. Over a period of three years, we minimized our CPB circuit by the introduction of integrated components and optimizing the circuit with a better configuration.…”

“…These systems need a different approach of operation technique and a team that is familiar with this equipment. 11,12 These techniques were beyond the scope of this retrospective audit. Until 2010, the CPB circuit in our institution consisted of an oxygenator with a separate arterial filter.…”

MECC Equipment

“…It can be utilized to automatically close the arterial line and prevent the device from depriming in case of massive air introduction. The ERC will close automatically also if retrograde fl ow is detected, preventing reverse fl ow through the system [ 77,78 ] .…”

Artificial Organs 2007: A Year in Review

“…Salvator Agati et al. (48) of the San Vincenzo Hospital (Messina, Italy) reported on their design of a pilot study to assess the safety and efficacy of a new phosphorylcholine‐coated, closed CPB system. The secondary end point was to compare results with two retrospectively matched cohorts of patients who underwent isolated coronary artery by‐pass graft (CABG) with nonphosphorylcholine‐bonded circuits and cardiotomy suction (Group II, n = 32) and off‐pump coronary artery by‐pass (Group III, n = 26).…”

“…Salvator Agati et al (48) of the San Vincenzo Hospital (Messina, Italy) reported on their design of a P.S. MALCHESKY 246 pilot study to assess the safety and efficacy of a new phosphorylcholine-coated, closed CPB system.…”