Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures

Abstract

BackgroundCoronary-artery-bypass-grafting (CABG) with conventional extracorporeal circulation (CECC) is associated with adverse effects such as systemic inflammatory response leading to a decrease in systemic vascular resistance and hemodynamic instability. Modern "less invasive" procedures have been established recently which potentially avoid negative side effects of CECC. The aim of this study was to compare perioperative outcome following coronary revascularization using either a minimized extracorporeal circuit (Mini-HLM) or off-pump technique (OPCAB).MethodsIn this prospective ethics-approved trial, 120 patients referred for CABG were randomly assigned either to off-pump coronary artery bypass (OPCAB) or to a Mini-HLM procedure. Patient demographics, preoperative characteristics and extensive postoperative outcome were analyzed for both groups. Hemodynamic data were measured at seven time points perioperatively.ResultsOperation-time was longer in the Mini-HLM group (178,3 ± 32,9 min) compared to OPCAB (133,2 ± 32,7 min, p < 0,001) with higher graft numbers in Mini-HLM group (3,11 ± 0,7 vs. 1,78 ± 0,7, p < 0.001). There were no significant differences in perioperative hemodynamic criteria, catecholaminergic support, hospital (p = 0,534) and intensive care unit stay (p = 0,880), ventilation time (p = 0,113), blood loss (p = 0,570), transfusion requirements, postoperative atrial fibrillation rate (p = 0,706) and neurocognitive disturbance (p = 0,297). No deaths and no myocardial infarctions were observed.ConclusionsCoronary revascularisation with Mini-HLM represents a suitable and "less invasive" procedure which achieves all benefits of OPCAB but may allow for less demanding revascularisation than OPCAB in special patients with complex coronary anatomy and can therefore be used both on a routine basis and in all "conversion" cases of OPCAB.

The effect of using the minimized cardio-pulmonary bypass Systems for Coronary Artery Bypass Grafting in diabetic patients

“…Despite all these potential beneficial effects for the mini-bypass systems, some other studies showed that there is no difference in post-operative outcomes [2,10,[18][19][20][21][22][23][24]. These discrepancies in clinical outcomes between different studies suggest that patients enrolled in those studies may represent a heterogenous group of patients who may benefit especially high-risk patients and those who may not benefit.…”

The Effect of Using the Minimized Cardio-pulmonary Bypass Systems for Coronary Artery Bypass Grafting in Diabetic Patients

“…Despite all these potential bene cial effects for the mini-bypass systems, some other studies showed that there is no difference in post-operative outcomes [2,10,[18][19][20][21][22][23][24]. These discrepancies in clinical outcomes between different studies suggest that patients enrolled in those studies may represent a heterogenous group of patients who may bene t especially high-risk patients and those who may not bene t.…”

Effects of Minimal Extracorporeal Circulation on the Systemic Inflammatory Response and the Need for Transfusion after Coronary Bypass Grafting Surgery

“…The minimal extracorporeal circulatory system consists of a centrifugal pump, a membrane oxygenator, a short heparin-coated line, and a vacuum line that can be added if necessary [14, 15]. The venous reservoir and the standard vacuum line in the conventional cardiopulmonary bypass system are not present in this circuit.…”