Minimal Extracorporeal Circulation: An Alternative for On-Pump and Off-Pump Coronary Revascularization

• Published in: The Annals of thoracic surgery Vol. 87; no. 3; pp. 766 - 772
• Main Authors: Puehler, Thomas, MD, Haneya, Assad, Philipp, Alois, Wiebe, Karsten, MD, Keyser, Andreas, MD, Rupprecht, Leopold, MD, Hirt, Stephan, MD, Kobuch, Reinhard, MD, Diez, Claudius, MD, Hilker, Michael, MD, Schmid, Christof, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2009; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass - methods; Coronary Artery Bypass, Off-Pump; Coronary heart disease; Equipment Design; Extracorporeal Circulation - instrumentation; Extracorporeal Circulation - methods; Female; Heart; Humans; Male; Medical sciences; Pneumology; Surgery; Treatment Outcome; 25; ECC; extracorporeal circulation; European System for Cardiac Operative Risk Evaluation; CK; activated clotting time; minimal extracorporeal circulation; off-pump coronary artery bypass graft surgery; coronary artery bypass graft surgery; OPCABG; ACT; EuroSCORE; creatine kinase; ICU; intensive care unit; CABG; MECC; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Coronary heart disease; Pump
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.11.050

Background Coronary artery bypass surgery employing minimal extracorporeal circulation (MECC) was compared with standard extracorporeal circulation (ECC) and off-pump coronary artery bypass graft surgery (OPCABG) with regard to the perioperative course. Methods From January 2004 to December 2007, 1,674 patients (n = 558 MECC, n = 558 ECC, n = 558 OPCABG) who underwent coronary bypass surgery were studied. The primary end point was in-hospital mortality; secondary end points were perioperative variables, intensive care, and in-hospital course. Results Demographic data, comorbidity, and the European System for Cardiac Operative Risk Evaluation score (MECC 3.0%, ECC 3.5%, OPCABG 3.2%) were similar among the groups, but in-hospital mortality for elective and urgent/emergent patients was lower in the MECC and OPCABG groups (MECC 3.2%, OPCABG 3.7%, ECC 6.9%; p < 0.05). The number of distal anastomoses was lowest in the OPCABG group, but comparable for MECC and ECC patients. Postoperative ventilation time, release of creatinine kinase, catecholamine therapy, drainage loss, and transfusion requirements were lower in the MECC and OPCABG groups, whereas stay in the intensive care unit was shorter only in the latter ( p < 0.05). Conclusions Minimal extracorporeal circulation is an easy and safe procedure for coronary artery bypass graft surgery. In selected patients, the advantages of MECC equal those of OPCABG. MECC should be considered as an alternative to OPCABG and standard ECC procedures.