Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass

Rémadi, Jean Paul; Rakotoarivelo, Zava; Marticho, Paul; Benamar, A.

doi:10.1016/j.ahj.2005.03.067

Cited by 152 publications

(168 citation statements)

References 19 publications

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“…The presence of barriers separating the blood from the air and decreasing the surface of contact of artificial materials with the blood gives measurable benefits, such as reduction in the incidence of the systemic inflammatory response syndrome (SIRS), although SIRS itself occurs almost always, with a variable degree of severity [1,2]. 'Mini-CPB' significantly decreases the incidence of early inflammatory response, which was confirmed in a randomised trial by Kiaii et al [3] and in other studies [1,4]. In our study we found earlier rise of the CRP and procalcitonin levels as well as leukocyte count in the 'mini-CPB' group than in the control group by approximately 24 h, with a gradual decrease thereafter in both groups.…”

Section: Discussionmentioning

confidence: 49%

“…In our study we found earlier rise of the CRP and procalcitonin levels as well as leukocyte count in the 'mini-CPB' group than in the control group by approximately 24 h, with a gradual decrease thereafter in both groups. Higher average levels of inflammatory markers in the 'mini-CPB' group This is related to higher HGB and HCT levels after the 'mini-CPB' procedure is conducted [4,5]. This significantly smaller decrease in HCT level is caused by minimal haemodilution.…”

Section: Discussionmentioning

confidence: 90%

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Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Commonly used cardiopulmonary bypass systems with cardiotomy reservoir, oxygenator, and roller pump require preoperative crystalloid filling. Radical reduction of the filling fluid volume and replacing it with the patient's own blood has a fundamental impact on the outcome. Aim:A comparison of cardiopulmonary bypass filled with the patient's blood, applied in Poland for the first time, and the classical system filled with crystalloids.Methods: Non-randomised trial in which patients undergoing coronary artery bypass grafting were divided into two groups: first operated on with use of cardiopulmonary bypass system with the patient's own blood priming, and a control group operated on with standard technique. Levels of haemoglobin (HGB), haematocrit (HCT), platelets, leukocytes, creatinine, protein, C-reactive protein, procalcitonin, volume of transfused blood products, postoperative drain output, time to extubation, and consumption of catecholamines were compared. Results:The results of a study comparing the classical system with the blood-filled system (n = 60) showed a significantly smaller decrease in HGB and HCT levels (p = 0.001), resulting in reduction of blood product transfusions by 75% (p = 0.03). The new type of extracorporeal circulation reduced the total postoperative drain output by approximately 28% (p = 0.003). The systemic inflammatory response syndrome (SIRS) was less pronounced and the tissue perfusion was better due to smaller degree of haemodilution leading to better organ and heart protection. The patients required shorter mechanical ventilation times in the perioperative period. Conclusions:The use of a new system of cardiopulmonary bypass filled with the patient's blood reduces the postoperative decrease in HGB and HCT, the amount of transfused blood products, and total postoperative drain output. It also shortens the time spent on mechanical ventilatory support.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 90%

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Mak¹,

Smolka

Kowalski

et al. 2016

Kardiol Pol

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“…18,19) The influence of surgical team set-up in our trial on higher bleeding in group C seems to be inconsequential.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study

Snircova

Jares

Malý³

et al. 2008

Int. Heart J.

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SUMMARYAlthough in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited.Sixty-five patients scheduled for coronary surgery were randomized into 3 groups:group A -conventional coronary artery bypass grafting, group B -off-pump surgery, and group C -coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected.Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardiopulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found. (Int From the

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“…(Table 1) is a comparison of these three larger randomized trials with at least 100 patients comparing M-CPB to C-CPB. Two of the studies [9,10] demonstrate a clear benefit with respect to bleeding and transfusion either in the OR, the first 24 hours, or in actual reoperations for bleeding. After isolated CABG with conventional CPB (C-CPB) it has been well demonstrated in large studies that perioperative red blood cell (RBC) transfusion is an important factor in postoperative mortality, infection, ischemic postoperative morbidity, hospital stay, and hospital costs [12].…”

Section: Common Features To M-cpbmentioning

confidence: 99%

“…Indeed, there are only three with more than 100 patients randomized in each arm [9][10][11]. (Table 1) is a comparison of these three larger randomized trials with at least 100 patients comparing M-CPB to C-CPB.…”

Section: Common Features To M-cpbmentioning

confidence: 99%

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

Chatterjee

2013

J Clin Exp Cardiolog

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Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass

Cited by 152 publications

References 19 publications

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Can cardiopulmonary bypass system with blood priming become a new standard in coronary surgery?

Postoperative Blood Loss in Coronary Surgery No Real Impact of Fibrinolysis Detected by Thromboelastography and D-Dimers. A Prospective, Randomized Study

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

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