Minimal Extracorporeal Circulation and Microplegia in the Setting of Urgent Coronary Artery Bypass Grafting

Koechlin, Luca; Gahl, Brigitta; Miazza, Jules; Zenklusen, Urs; Rrahmani, Bejtush; Vasiloi, Ion; Santer, David; Berdajs, Denis; Eckstein, Friedrich S.; Reuthebuch, Oliver

doi:10.3390/jcm11247488

Cited by 2 publications

References 21 publications

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Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery – A double-blinded randomized control trial

Jenni,

Kovacic,

Mihalj

et al. 2024

Perfusion

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Objective Minimally invasive extracorporeal circulation has been shown to be non-inferior or even superior to conventional cardiopulmonary bypass circuits in isolated coronary artery bypass grafting, but there is little evidence whether the addition of a heparin-coated circuit can further reduce the inflammatory response and amount of bleeding in these patients. Methods A single-center randomized control trial enrolled 49 adult patients scheduled to undergo isolated coronary artery bypass grafting with minimally invasive extracorporeal circulation (MiECC) between January 2015 and December 2018. Patients were randomized 1:1 to either the heparin-coated circuit group, or the uncoated (control) circuit group. The primary outcome was chest tube output 18 h after weaning from MiECC, and secondary outcomes included inflammatory (TNF-α, IL-6, IL-8, IL-10) and complement (C3a, C4d, C5a, sC5b-9) biomarkers, platelet count and function (D2D, TAT, SDC1, PF4), number of transfused blood products, and 30-day survival. Results Patients were randomized to undergo myocardial revascularization using heparin-coated circuits ( n = 25), and to the uncoated MiECC circuit ( n = 24), with comparable baseline demographics. No significant difference was observed in chest tube output and for all secondary outcomes. IL-6 and IL-8 were increased from baseline at 18 h after weaning (effect size 0.29 and 0.05, respectively) and sC5b-9 was lower (effect size 0.11) in the heparin-coated than in the uncoated MiECC, although not significantly different. Conclusions Compared with an uncoated MiECC circuit, heparin-coated MiECC circuit was not associated with a reduction in postoperative bleeding, transfusion, inflammation, complement activation, and platelet biomarkers, following isolated coronary artery bypass grafting.

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Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery – A double-blinded randomized control trial

Jenni,

Kovacic,

Mihalj

et al. 2024

Perfusion

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Conservative Fluid Resuscitation Protocol Does Not Reduce the Incidence of Reoperation for Bleeding during the First 48 Hours after Emergency CABG

Bruno,

Varayath,

Gahl

et al. 2023

Preprint

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BACKGROUND Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (CABG) has been identified as an independent risk factor for mortality with the incidence of in-hospital death ranging from 9–22%. A potential cause might be coagulopathy induced by dilution due to liberal fluid management. The aim of this study was to evaluate the effects of two volume resuscitation protocols on ROB after CABG.METHODS In this retrospective single-center study, all patients who underwent emergency CABG (n = 265) at our institution between 2011 and 2020 were included. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 hours after intensive care unit admission according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed.RESULTS The incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II and laboratory values. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables.CONCLUSIONS Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Ethics approval and consent to participate: This study has been approved by the Ethics Committee of Northwestern and Central Switzerland. (Project-ID: 2020 − 01833)Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study)

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Minimal Extracorporeal Circulation and Microplegia in the Setting of Urgent Coronary Artery Bypass Grafting

Cited by 2 publications

References 21 publications

Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery – A double-blinded randomized control trial

Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery – A double-blinded randomized control trial

Conservative Fluid Resuscitation Protocol Does Not Reduce the Incidence of Reoperation for Bleeding during the First 48 Hours after Emergency CABG

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