Mini-extracorporeal circulation minimizes coagulation abnormalities and ameliorates pulmonary outcome in coronary artery bypass grafting surgery

Abstract

Hemostasis is impaired during CABG and coagulation abnormalities often result in clinically relevant organ dysfunctions, eventually increasing morbidity and mortality rates. Fifteen consecutive patients with coronary artery disease submitted to conventional extracorporeal circulation (cECC) have been compared with 15 matched patients, using mini-ECC (MECC). Postoperative lung function was evaluated according to gas exchange, intubation time and lung injury score. In the MECC group, thrombin-antithrombin complex levels (TaTc), prothrombin fragments (PF1+2) formation and thromboelastography (TEG) clotting times were lower compared to the cECC group (p=0.002 and p<0.001, respectively) whereas postoperative blood loss was higher in the cECC group (p=0.030) and more patients required blood transfusion (p=0.020). In the MECC group, postoperative gas exchange values were better, intubation time shorter and lung injury score lower (p<0.001 for all comparisons). Our study suggests that MECC induces less coagulation disorders, leading to lower postoperative blood loss and better postoperative lung function. This approach may be advantageous in high-risk patients.

Impact of minimally invasive extracorporeal circulation on coagulation—a randomized trial

“…In accordance with other studies, we observed reduced haemodilution until first postoperative day in the MiECC group as measured by significantly lower haematocrit levels and significantly less weight gain [7,25,26]. Our results disprove the theory that haemodilution is a main factor contributing to impaired haemostasis as neither coagulation factors nor bleeding end points were correlated to the degree of haemodilution.…”

Evaluation of an Innovative Device for Mitral Valve Regurgitation: Experimental Acute In Vivo Results

“…Furthermore, the surgical procedure is simplified with a shorter procedural time and would likely be advantageous in minimally invasive procedures, in cases of challenging anatomy, in combined procedures, or in any cases where reduced CPB and aortic cross-clamping time are particularly advisable. [24][25][26][27][28] The crucial time in conventional chordae implantation is the anchoring procedure to the papillary muscle and correct length measurements. These 2 procedures are actually done prior to the ischemic time and cardiac arrest.…”

Effect of Different Types of Extracorporeal Circulation on Hemostasis Activation and Methods for its Monitoring

“…Significant is also the reduction of priming volume, which substantially contributes to the activation of hemostasis (according to inconsistent literature data, purely crystalloid priming leads to hypercoagulation, use of colloids to hypocoagulation). There is a variety of papers in the literature documenting a lower level of systemic inflammatory response syndrome (SIRS) and hemostasis activation when using MiECC to conventional ECC, unfortunately without clear clinical benefit, except for reducing the volume of administered transfusion products [4,5]. Thrombocytes are one of the most affected key components of haemostasis in ECC.…”