Coronary Artery Bypass Graft with Minimal Extracorporeal Circulation
Background: To evaluate the advantages and benefits of a minimized extracorporeal circulation system in the performance of coronary artery bypass grafts.
Methods: From September 2000 to February 2003, 279 consecutive patients underwent isolated coronary artery bypass grafting with minimal extracorporeal circulation. A group of 243 patients at good risk as defined by a Euro-SCORE of 3 underwent complete bypass and blood cardioplegia, and a high-risk group of 45 patients (EuroSCORE, 6) underwent operations with partial assistance and a beating heart. In a prospective substudy analysis of thrombocyte and platelet counts, transfusion requirements, PaO2/FIO2, leukocyte count, C-reactive protein level, postoperative bleeding, intensive care unit stay, and ventilation, 40 patients from the good-risk group were matched and compared with 40 patients who underwent operations with a conventional extracorporeal system.
Results: Revascularization was complete with a mean of 2.8 distal anastomoses in the good-risk group and 2.4 in the high-risk group. Mortality rates were 1.2% and 4%, respectively. The system provided either complete or partial bypass assistance and depended on preload and afterload. The system also allowed easy access to all territories with perfect hemodynamic stability. Priming was reduced to 400 mL, and arterial and venous saturation monitoring revealed excellent maintenance of pH values. No complications or failure of the system occurred. Hemodilution, inflammatory response, and transfusion requirements were reduced in the minimal extracorporeal circulation group.
Conclusions: Minimal extracorporeal circulation allows minimal hemodilution and reduces transfusion requirements. The method allows safe and complete revascularization of either an arrested or a beating heart.
Ascione R, Lloyd CT, Gones WJ, Caputo M, Bryan AJ, Angelini GD. 1999. Beating versus arrested heart revascularisation: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 11:685-90.nBergsland J, Hasnan S, Levin AN, Bhayana J, Lajos TZ, Salerno TA. 1997. Coronary artery bypass grafting without cardiopulmonary bypass: an attractive alternative in high risk patients. Eur J Cardiothorac Surg 11:876-80.nCalafiore AM, Di Gimmarco G, Teodori G, et al. 1998. Midterm results after minimally invasive coronary surgery (LAST operation). J Thorac Cardiovasc Surg 115:763-71.nCartier R, Brann S, Dagenais F, Martineau R, Couturier A. 2000. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. J Thorac Cardiovasc Surg 119:221-9.nPagni S, Qaqish NK, Senior DG, Spence PA. 1997. Anastomotic complications in minimally invasive coronary bypass grafting. Ann Thorac Surg 63(suppl 6):S64-7.nSternick L, Moshkovitz Y, Hod H, Mohr R. 2000. Comparison of myocardial revascularisation without cardiopulmonary bypass to standard open-heart technique in patients with left ventricular dysfunction. Eur J Cardiothorac Surg 11:123-8.nGründeman PF, Boest C, van Hewaarden JA, Verlann CW, Jansen EW. 1998. Vertical displacement of the beating heart by the Octopus tissue stabilizer: influence on coronary flow. Ann Thorac Surg 65:1348-52.nGundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. 1998. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Surg 65:1348-8.nHammerschmidt DE, Stroncek DF, Bowers TK, et al. 1981. Complement activation and neutropenia occurring during cardiopulmonary bypass. J Thorac Cardiovasc Surg 81:370-7.nLocker C, Shapira J, Paz Y, et al. 2000. Emergency myocardial revascularisation for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass. Eur J Cardiothorac Surg 17:234-8.nLönn U, Peterzén B, Carnstam B, Casimir-Ahn H. 1999. Beating heart coronary surgery supported by an axial blood flow pump. Ann Thorac Surg 67:99-104.nNierich AP, Diephuis J, Jansen EW, Borst C, Knappe JT. 2000. Heart displacement during off-pump CABG: how well is it tolerated? Ann Thorac Surg 70:466-72.n
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