Impact of minimally invasive extracorporeal circuits on octogenarians undergoing coronary artery bypass grafting. Have we been looking in the wrong direction?†

El-Essawi, Aschraf; Breitenbach, Ingo; Haupt, Benjamin; Brouwer, René M.H.J.; Baraki, Hassina; Harringer, Wolfgang

doi:10.1093/ejcts/ezx156

Cited by 10 publications

(11 citation statements)

References 19 publications

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“…Previous studies of patients undergoing coronary surgery or simple valve surgery with the use of a MiECC revealed a relatively short mean ECC time (ranging from 74.9 to 112 minutes) and a mean aortic clamp time (ranging from 49.9 to 86 minutes) 5,6,15‐18 . Our overall mean ECC time (159 minutes) and overall mean aortic clamp time (109 minutes) were comparatively long but akin to the reported mean ECC times (144‐181 minutes) and aortic clamp times (90‐107 minutes) recorded during ATAAD surgeries performed under mild‐to‐moderate hypothermia 21‐23 .…”

Section: Discussionsupporting

confidence: 64%

“…Therefore, there remain no clear guidelines regarding the optimal transfusion volume. Whether MiECC can reduce the transfusion volume in ATAAD surgery, as it does in coronary surgery, 5‐8 remains a question. Chu et al assessed the incidence of blood transfusion in patients undergoing proximal thoracic aortic surgery (85 elective cases and 53 emergency cases) 29 .…”

Section: Discussionmentioning

confidence: 99%

“…Effective MiECC systems include a closed circuit, biologically inert blood contact surfaces, a centrifugal pump, a membrane oxygenator, a heat exchanger, a cardioplegia system, venous bubble trap/venous air removal device, and a shed blood management system; the priming volume is low 4 . Advantages of MiECC over conventional ECC include a reduced blood transfusion requirement, 5‐8 an attenuated inflammatory response, 8‐10 prevention of atrial fibrillation, 5,9 preservation of renal function, 8 and improved myocardial protection 7,9 . Despite such benefits, MiECC has not yet been standardized.…”

Section: Introductionmentioning

confidence: 99%

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Minimized perfusion circuit for acute type A aortic dissection surgery

et al. 2020

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A minimized perfusion circuit (MPC) may reduce transfusion requirement and inflammatory response. Its use, however, has not been standardized for complicated cardiovascular surgery. We assessed outcomes of surgery for acute type A aortic dissection (ATAAD) performed with a MPC under circulatory arrest. The study involved 706 patients treated surgically for ATAAD (by hemiarch repair [n = 571] or total arch repair [n = 135]). Total arch repair was performed using selective antegrade cerebral perfusion. Our MPC, a semi‐closed bypass system, incorporating a completely closed circuit and a level‐sensing reservoir in the venous circuit, was used. Clinical variables, transfusion volume, and outcomes were investigated in patients who underwent hemiarch repair or total arch repair. The overall incidences of shock, organ ischemia, and coagulopathy (prothrombin time–international normalized ratio >1.5) were 26%, 35%, and 8%, respectively. Mean extracorporeal circulation (ECC) time was 149 minutes for the hemiarch repair group and 241 minutes for the total arch repair group, respectively. No patient required conversion to conventional ECC, and there were no complications related to the use of the MPC. The need for transfusion (98% vs. 91%, P = .017) and median transfusion volume (1970 vs. 1680 mL, P = .002) was increased in the total arch repair group. Neither in‐hospital mortality (total arch; 12% vs. hemiarch; 7%, P = .11) nor 10‐year survival (74.4% vs. 68.4%, P = .79) differed significantly. Outcomes of surgery for ATAAD performed with the MPC were acceptable. The possibility of transfusion and transfusion volume remains high during such surgery, despite the use of the MPC.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimized perfusion circuit for acute type A aortic dissection surgery

et al. 2020

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“…Использование MiECC имеет преимущество у пациентов высокого риска: старшей возрастной группы и пожилых, с сахарным диабетом, предоперационной анемией, синдромом малого сердечного выброса, предполагаемым длительным ИК и другими категориями высокого риска [10,41,43,[52][53][54].…”

Section: преимущества системunclassified

“…По одним данным, различия в потребности в гемотрансфузиях при проведении ИК с обычным контуром и MiECC отсутствуют [51,63]. По другим данным, значительно меньше периоперационных трансфузий компонентов крови при использовании MiECC, в том числе и у пациентов старшей возрастной группы, у пациентов с исходной анемией и при выполнении экстренных операций [10,43,52,54].…”

Section: кровопотеря и трансфузииunclassified

Haemostasis and minimally invasive extracorporeal circulation

Kornev¹,

Шелухин²

2019

PKiK

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Advances in extracorporeal circulation using a minimally invasive circuit have rapidly emerged, and the components and biocoatings of the minimally invasive extracorporeal circuit (MiECC) have improved. The application range of minimally invasive cardiopulmonary bypass has expanded, however the main indications for the use of MiECCs during cardiac surgery have not yet been systematized. To the best of our knowledge, no guidelines for anticoagulant therapy regimens during minimally invasive cardiopulmonary bypass exist, and its effect on blood loss and the activation of coagulation in the perioperative period remain unclear. The present review highlighted the components of the circuit and the practical aspects of using MiECC. We formulated indications for the use of minimally invasive circuits and classified biocompatible coatings used to reduce the contact activation of haemostasis. According to the literature, when performing cardiopulmonary bypass with MiECC, the physiological haemostatic balance is disturbed. The detected changes in plasma haemostasis do not allow drawing conclusions regarding the advantages of MiECC, despite its clinical benefits. Multicentre randomized trials that comply with the rules of the pre-analytical stage of haemostasis and use global tests (thrombin generation test, thrombodynamics test, etc.) are required. The available studies on the haemostatic system using MiECC are not adequate for determining whether MiECCs on a haemostatic system are recommendable. However, MiECCs allow physicians to get closer to the fast track cardiac surgery ideal.Received 7 October 2019. Revised 14 November 2019. Accepted 18 November 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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