Initial experiences with a centrifugal-pump based minimal invasive extracorporeal circulation system in pediatric congenital cardiac surgery

Abstract

Background: Minimal invasive extracorporeal circulation (MiECC) circuits are an established alternative to conventional extracorporeal circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac surgery, this perfusion concept appears particularly attractive to pediatric cardiac surgery. So far, there are no reports on the clinical application of a MiECC system for corrective surgery in neonates and children. We report our initial experiences by using a MiECC system in pediatric cardiac surgery. Methods: A total of 38 pediatric patients underwent surgical interventions for a variety of congenital heart disease from March 2017 until August 2018 with a MiECC. Following the classification of MiECC circuits by the Minimal invasive Extra-Corporeal Technologies International Society (MiECTIS), type I and type III perfusion circuits were assembled depending on the planned intervention: type I for closed heart interventions and type III for open heart procedures. Primary outcome was conversion to CECC, secondary endpoints included major adverse cardiac or cerebrovascular events (MACCE). Results: MiECC perfusion was successfully performed in all patients (100%). Median patient age was 9.5 months (range, 0.2-176 months) with a median weight of 8.1 kg (range, 2.3-49 kg). For both MiECC types no system related technical complications were encountered. Beating heart procedures were performed in 23 cases (60%) at normothermia, while in 15 (40%) interventions cardioplegic cardiac arrest was induced at mild hypothermia. All patients had an uneventful perioperative course with no in-hospital mortality. MACCE did not occur during the hospitalization period. Conclusions: MiECC can be performed by using standard techniques for closed and open cardiac procedures for the correction of a variety of malformations in neonates and children with good results and uneventful postoperative course.

Safety of bloodless open-heart surgery on cardiopulmonary bypass in selected children: A single center experience with minimal invasive extracorporeal circulation

“…Many institutions have reported a wide range of success rates of bloodless cardiac surgery on MiECC, with the requirement of blood transfusion increasing due to the higher complexity of the underlying congenital heart disease and the younger age of the patients. 15,19,23,24,25,29–33 In contrast, our cohort represented the older patients with low STAT risk category, and almost all of our patients (96%) undergoing bloodless cardiac surgery finished their hospital stay without receiving any blood or blood products. The patients who received blood product transfusions after bloodless cardiac surgery had more in-hospital complications during their hospital stay than those without postoperative blood transfusions.…”

Reduced Invasiveness of Cardiopulmonary Bypass: The Mini-Circuit and the Micro-Cardioplegia

“…Our initial experience with a pilot group of 38 patients in 2017-2018 using a type I circuit for closed and a type III perfusion circuits for open heart procedures was very encouraging [14]. Minimal invasive perfusion was successfully performed in all patients without technical complications nor any need for conversion.…”

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

“…Preliminary evidence obtained in this series suggests that expansion of the MiECC strategy to pediatric cardiac surgery opts for improved perioperative outcome that is similar to the positive effects and results demonstrated in adult cardiac surgery. 64 Implementation of modular systems in the pediatric setting allows for the adjustment of the perfusion system to the specific requirements of the intervention. Wider adoption by the pediatric cardiac surgical community is strongly advocated in order to obtain results from large multicenter studies that could further delineate potential benefits of MiECC in pediatric population.…”