Outcome after coronary artery bypass surgery with miniaturized versus conventional cardiopulmonary bypass

Abstract

We have reviewed the results of our experience with the use of miniaturized (Mini-CPB) versus conventional (C-CPB) cardiopulmonary bypass in coronary artery bypass surgery (CABG). This study included 365 patients who underwent CABG with C-CPB and 101 patients with Mini-CPB. In-hospital mortality was lower in the C-CPB group (1.4% vs. 3.0%, P = 0.38). A better, but not statistically significant, immediate outcome was observed in the C-CPB group as indicated by a shorter length of stay in the intensive care unit as well as a lower incidence of combined adverse end-point. However, this was probably due to significantly higher operative risk in the Mini-CPB group (logistic EuroSCORE: 8.5 +/- 10.0 vs. 4.6 +/- 7.1, P < 0.0001). Seventy-seven propensity score-matched pairs had similar immediate postoperative results after Mini-CPB and C-CPB (30-day mortality: 1.3% vs. 1.3%; stroke: 0% vs. 0%; intensive care unit stay > or = 5 days: 6.5% vs. 9.1%; combined adverse events: 14.3% vs. 11.7%). Mini-CPB achieves similar results to C-CPB in patients undergoing isolated CABG. The potential efficacy of Mini-CPB is expected to be more evident in high-risk patients or in complex cardiac surgery requiring much longer cardiopulmonary perfusion.

The “benefits” of the mini-extracorporeal circulation in the minimal invasive cardiac surgery era

“…This hemodilution potentially affects hemostasis, decreasing levels of coagulation and fibrinolytic proteins [15]. Additionally, the risk of long-term morbidity and short-term mortality is increased by hemodilution [29]. Increased blood transfusion is often required due to excessive hemodilution [30] to provide adequate oxygen delivery to the vital organs [2].…”

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

“…In a propensity score matched group, Rimpilainen et al found that the efficacy of M-CPB was more pronounced the more complex the cardiac surgical procedure that necessitated longer perfusion times [7]. This is similar to large analyses that demonstrate that the benefit in OPCAB is in high risk patients [25].…”

“…Using a lower priming volume has been shown to reduce transfusions by about 30% [6]. Finally, hemodilution has been implicated as a major factor in organ dysfunction, short-term mortality, and long-term morbidity [7].…”

Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: What the evidence shows?

“…As such, among the aims of the mECC system are a reduction in haemodilution, post-bypass coagulopathy and the inflammatory response to bypass. Recent publications have suggested that, to a certain extent, this has been achieved, associating mECC with a reduction in inflammation, haemodilution, post-operative blood transfusion requirements and stroke rates when compared to traditional CECC 10-12 . No short-term difference in morbidity or mortality has been shown between mECC and CECC, and long-term data is yet to be established.…”