The minimized extracorporeal circulation system causes less inflammation and organ damage

Abstract

The minimized extracorporeal circulation system (MECC) is being used to reduce priming volume and blood/polymer contact during cardiac procedures. In this study, we evaluated the efficacy and potential advantages of the system in coronary artery bypass graft (CABG) patients. We included two groups of patients destined for CABG in a prospective, randomized study: Group A was operated on the usual pump (n = 30) while Group B was operated using the MECC (n = 50). Pre-operative demographics, intra-operative times and values as well as a series of post-operative outcome data (blood loss, transfusion requirements, ventilation time, ICU and hospital stay) were recorded. CK, CK-MB, troponin-T, IL-6 and IL-8 were measured. Pre-operative and post-operative lung function were assessed. In the MECC-operated group, patients developed less post-operative troponin-T (0.2 +/- 0.3 vs. 0.5 +/- 0.5 ng/mL, p=0.031) and less IL-8 (13.8 +/- 5 vs. 22.5 +/- 0.5 microg/L, p = 0.05). While blood loss was comparable in both groups, packed red blood cells and fresh frozen plasma were given less frequently in the MECC group (p = 0.015 resp. 0.022). The one-tailed Student's t-test revealed shorter bypass time in the MECC group (74 +/- 17 vs. 82 +/- 24 min). There was no difference in ventilation and ICU-time (patients were not treated in a fast-track fashion). The FEV1 was better in the MECC group (relative values: 70.1 +/- 18.2% vs. 61.1 +/- 12.3%, p = 0.02). Utilization of the MECC may cause less cytokine (IL-8) liberation, owing to less blood/tubing contact, as well as less red blood cell and fresh frozen plasma demand. It may also be the circuit in patients with chronic obstructive pulmonary disease (COPD).

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

“…Other studies revealed significant decreased IL-8 levels using the MECC system. 19,20 In contrast, this study did not show lower levels of inflammatory markers such as IL-6, IL-8, and TNF-alpha in both mini-CPB groups compared with CCPB. These re- sults are supported by other groups 20,24,25 and might be attributed to significant longer OR, ECC, and cross-clamp time in both mini-CPB groups compared with CCPB.…”

“…Other studies reporting on mini-CPB systems support these results. 17,19,32,36 Limitations In this study, all patients without the indicated exclusion criteria undergoing elective coronary artery bypass grafting were included. Because our hospital is a university center and surgical training is performed, these elective low-risk patients are operated by either experienced or inexperienced surgeons.…”

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

“…Indeed, several investigators have demonstrated better postoperative outcome in terms of reduced inflammatory response and postoperative blood loss. [12][13][14][15] However, to our knowledge, there are no studies that include PF1+2, TaTc formation and clotting evaluation by thromboelastography (TEG). The aim of this study was to evaluate the impact of either conventional ECC (cECC) or MECC in terms of coagulation disorders, blood loss and early postoperative lung function in patients undergoing CABG.…”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

“…(Level of Evidence: B) 2. High thoracic epidural analgesia may be considered to improve lung function after CABG(37,1202). (Level of Evidence: B)…”