Prospective, Randomized Study Comparing Two Different Minimized versus Conventional Cardiopulmonary Bypass Systems

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Conventional cardiopulmonary bypass (CCPB) is a major trigger of inflammatory response. We aimed to assess the impact of two different minimized cardiopulmonary bypass systems (mini-CPB) with and without Bioline-coating compared with CCPB regarding organ function, inflammatory response, and early clinical outcome. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> In a prospective, randomized study, 120 patients underwent elective coronary artery bypass grafting and were randomized into three groups: mini-CPB using a Bioline-coated (group A, n = 40) or an uncoated (group B, n = 40) circuit, or CCPB (group C, n = 40). Cytokines (interleukin-6, interleukin-8, and tumor necrosis factor-alpha), myocardial markers (creatine kinase [CK], CK-MB, and troponin-T), hematocrit, and platelet counts were measured up to 48 hours postoperatively. Early clinical outcome was assessed at 3 months postoperatively. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Demographics, number of distal anastomoses, ventilation time, blood loss, intensive care unit, and hospital stay were comparable (P = not significant). Extracorporeal circulation and cross-clamp time were significantly longer in group A and B versus C (P &lt; 0.005). No significant differences could be found in the release of interleukin-6, interleukin-8, and tumor necrosis factor-alpha among groups. Myocardial markers were significantly reduced in group A and B versus group C (P &lt; 0.001). Hematocrit and platelet counts did not differ among the groups. No differences could be found in early clinical outcome up to 3 months. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> This study showed significant better myocardial preservation with lower CK-MB and troponin-T levels in both mini-CPB groups. No significant differences could be found in terms of inflammation, hematologic effects, and early clinical outcome. </jats:p></jats:sec>

What We have Learned about Minimized Extracorporeal Circulation versus Conventional Extracorporeal Circulation: An Updated Meta-Analysis

“…A total of 1276 potentially relevant studies were identified after searching; of these, 77 studies were selected by review of titles and abstracts, and 36 studies were excluded after assessment of the full text. Finally, 41 RCTs (1, 5, 14–52) were included according to our prespecified inclusion criteria, enrolling 3744 adult patients undergoing cardiac surgery (Fig. 1).…”