Mini–Cardiopulmonary Bypass System: Results of a Prospective Randomized Study

Beghi, Cesare; Nicolini, Francesco; Agostinelli, Andrea; Borrello, Bruno; Budillon, Alessandro Maria; Bacciottini, Franco; Friggeri, Marco; Costa, Antonietta; Belli, Laura; Battistelli, Luisita; Gherli, Tiziano

doi:10.1016/j.athoracsur.2005.10.015

Cited by 82 publications

(104 citation statements)

References 9 publications

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“…Damit wird der Kontakt von Blut mit der Umgebungsluft durch intermittierendes Saugen minimiert. Diese Änderung ist wesentlich, da die aktuelle Datenlage über die MECC-Perfusion immer unter Verwendung eines zusätzlichen Cell-saver-Systems erhoben wurde, was sich einerseits auf die Kosten ungünstig auswirkt und anderseits sicherlich einen nicht unwesentlichen Einfluss auf die postoperative Gerinnungs-und Entzündungs-reaktion nach sich zieht [8][9][10]. Die Gruppe aus Regensburg konnte aufzeigen, dass die MECC-Perfusion einen günstigen Einfluss auf den peri-und postoperativen Transfusionsbedarf hat und die postoperativen Komplikationen, verglichen mit der konventionellen HLM, reduziert werden können [8].…”

Section: Discussionunclassified

Vorteile des minimalen extrakorporellen Kreislaufs in der Koronarchirurgie

Immer¹,

Häusler²,

Valerio³

et al. 2007

Schweiz Ärzteztg

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SummaryObjective: Minimal extracorporeal circulation (MECC) is a new perfusion technology, which includes a centrifugal pump and an optoelectrical suction system. The main advantage consists in a significant reduction of the priming volume. Aim of the present study was to analyse if MECC has a positive effect in term of reduction of the activation of inflammatory markers and on the incidence of postoperative atrial fibrillation (AF) in comparison to conventional cardiopulmonary bypass (CPB). Methods: Two collectives have been studied: 30 patients scheduled for isolated coronary artery bypass graft (CABG) surgery were randomised to either receive MECC or CPB. Activation of inflammatory markers (IL-6, SC5-b9, Human Lactoferrin) was analysed. In a second collective 86 patients were analysed to evaluate the incidence of AF: 41 patients (47.7%) with CPB and 45 patients (52.3%) with MECC. Patients' characteristics were similar in both groups. In-hospital outcome was assessed. Results: Inflammatory markers were significant lower in the MECC-group early post operative. AF was documented in 16 patients (39.0%) of the CPB and in 5 patients (11.1%) of the MECC group (p <0.05). Postoperative the increase of weight was less pronounced in the MECC group (2.9 ± 2.4% vs 4.4 ± 2.6%; p <0.05). Antiarrhythmic medication was similar in both groups and administered in 95.1% of the patients in the CPB and in 93.3% in the MECC group (p = ns). No differences were found in serum potassium between the two groups (p = ns). Conclusion: MECC is an established and safe perfusion technique. Activation of inflammatory markers is less pronounced in MECC than in CPB patients. The reduction of the priming volume leads to a less pronounced volume shift in the early postoperative period and reduces the incidence of postoperative AF, compared to patients operated with CPB. Resultate: Die Entzündungsmarker waren früh postoperativ in der MECC-Gruppe signifikant tiefer. VHF konnte bei 16 Patienten (39,0%) aus der HLM-und bei 5 Patienten (11,1%) aus der MECC-Gruppe (p <0,05) dokumentiert werden. Postoperativ war der Gewichtsanstieg weniger ausgeprägt in der MECCGruppe (2,9 ± 2,4% vs 4,4 ± 2,6%; p <0,05). Die antiarrhythmische Medikation mit Betablocker war in beiden Gruppen mit einem Anteil von 95,1% in der HLM-und 93,3% in der MECC-Gruppe identisch (p = ns). Die Serumkalium-Werte waren ebenfalls in beiden Gruppen identisch (p = ns).

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Section: Discussionunclassified

Vorteile des minimalen extrakorporellen Kreislaufs in der Koronarchirurgie

Immer¹,

Häusler²,

Valerio³

et al. 2007

Schweiz Ärzteztg

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“…Studies show that the use of miniinvasive systems result in a decrease in quantity of administered blood derivatives, a decrease in blood loss, lower incidence of postoperative neurologic complications, a shorter stay in the ICU, period of artificial ventilation and total hospital stay [4][5][6][7][8] . On the other hand some studies do not entirely confirm the positive clinical effect of using minisystems 13 , even though the laboratory tests of these studies lean towards miniinvasive systems compared to standard CPB.…”

Section: Discussionmentioning

confidence: 99%

“…One of the latest complex innovations is miniaturized CPB (mini CPB). The use of more biocompatible materials and minimization of equipment and internal surface of the system can reduce pathological reactions [4][5][6][7][8] . Volume constant perfusion (perfusion without a reservoir) is a major advantage of mini CPB, but it can be associated with significant problems.…”

Section: Introductionmentioning

confidence: 99%

Peripheral tissue oxygenation during standard CPB and miniaturized CPB (direct oxymetric tissue perfusion monitoring study)

Mandak¹,

Brzek²,

Svitek³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion. Methods. 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle. Results. Lower priming in Group B (870 ± 221 mL) vs. Group A (1502 ± 48 mL) and significantly reduced hemodilution during mini CPB (Group B 25.3 ± 1.1% vs. Group A 30.1 ± 2.3%) were recorded. Higher and continuous blood flow during perfusion was analysed in Group A (4.58 ± 0.34 L.min ). There was a direct correlation between mean arterial pressure (MAP) and ptO 2 in Group A during CPB and a direct correlation between pump blood flow and MAP during CPB in Group B. Higher levels of ptO 2 during CPB and surgery after CPB in comparison with initial levels were found in Group B. Decreased ptO 2 levels after surgery were found in both groups. Conclusion. Mini CPB enables perfusion with a relatively low flow. The results of this study suggest that a flow decrease in mini CPB is well tolerated by the organism.

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“…An increase of IL-1 was found after ECC with a peak concentration after 24 hours (Fromes et al 2002). IL-6 is produced and released by the monocytes and endothelial cells following a stimulus by the IL-1 and TNF-The IL-6 has the peak concentration few hours after the end of ECC and gradual decrease within the following 24 hours (Beghi et al 2006;Whipperman et al 2005;Fromes et al 2002). The IL-6 concentration increase also after major noncardiac operation and the peak concentration occur after 6-24 hours the end of operation.…”

Section: Other Inflammation Mediators 321 Cytokinesmentioning

confidence: 99%

“…All components of MECC circuit are pretreated with heparin according to different techniques available on the market. The heparin pre-treatment of the circuit minimizes the systemic heparinization dose requirements (usually half dose of conventional ECC: 150IU/Kg instead of 300IU/Kg) (Curtis et al 2010;Formica et al 2009, Puheler et al 2009Beghi et. 2006) and provides biocompatibility for blood cells (Koivisto et al 2010;Remadi et al 2007;Remadi et al 2004;Fromes et al 2002;) Fig.…”

Section: Anatomy Of the Miniaturized Extracorporeal Circulation Systemmentioning

confidence: 99%