Beating-Heart Coronary Artery Bypass Grafting Using a Miniaturized Extracorporeal Circulation System


  • Delawer Reber
  • Markus Fritz
  • Paschalis Tossios
  • Dirk Buchwald
  • Michael Lindstaedt
  • Krzysztof Klak
  • Peter Marks
  • Axel Laczkovics



Background. Experience with miniaturized coronary artery bypass (CAB) systems in coronary artery bypass graft (CABG) surgery on the beating heart is limited. We used a relatively new miniaturized cardiopulmonary bypass (CPB) system, which we termed assisted CAB (ACAB), to perform CABG on the beating heart in 110 patients, and we analyzed clinical outcomes in this patient group.

Methods. Between January 2004 and September 2006, we used ACAB to perform CABG on the beating heart in 110 patients. The mean patient age was 73 ± 8.1 years.

The ACAB system uses a small prime volume of only 500 mL, and the circuit is shorter than that used in conventional CPB. In addition, the tubing and oxygenator systems were surface-coated with phosphorylcholine. The initial heparin dose was 150 IU/kg, with a target activated clotting time of >250 seconds. With this management, none of the patients experienced system thrombosis. We did not use cardioplegia or aortic crossclamping and did not routinely retransfuse cardiotomy blood. Observational data for the 110 patients were analyzed.

Results. The mean number of anastomoses performed was 2.67. The rate of perioperative infarction was 1.8% (2 patients). Perioperative mortality was 7% (8 patients). The mean EuroSCORE for all patients was 6.4 ± 4, whereas it was 13.75 ± 6.18 for the patients who died. Mean CPB time was 64.96 ± 16.66 minutes.

Conclusion. In our experience, beating heart CABG supported by a miniaturized CPB is a safe procedure with acceptable perioperative results.


Ascione R, Llyod CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. 2000. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg69:1198-204.nBeghi C, Nicolini F, Agostinelli A, et al. 2006. Mini-cardiopulmonary bypass system: results of a prospective randomized study. Ann Thorac Surg81:1396-400.nButler J, Rocker GM, Westaby S. 1993. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg55:552-9.nFromes Y, Gaillard D, Ponzio O, et al. 2000. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg22:527.nGerritsen WB, van Boven WJ, Wesselink RM. 2007. Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation. Transfus Med.16:329-34.nGibbon JH Jr. 1953. Application of a mechanical heart and lung apparatus to cardiac surgery. In: Recent advances in cardiovascular surgery. Minneapolis, (MN): University of Minnesota. p. 107-13.nKamiya H, Kofidis T, Haverich A, Klima U. 2006. Preliminary experience with the mini-extracorporeal circulation system (Medtronic resting heart system). Interact Cardiovasc Thorac Surg6:680-682.nKirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. 1983. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg86:845-857.nNashef SAM, Roques F, Michel P, Gaucducheau E, Salamon R. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg16:9-13.nNollert G, Schwabenland I, Maktav D, et al. 2005. Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammatory and coagulation but loss of safety margins. Ann Thorac Surg80:2326-32.nOhata T, Mitsuno M, Yamamura M, et al. 2007. Minimal cardiopulmonary bypass attenuates neutrophil activation and cytokine release in coronary artery bypass grafting. Artif Organs10:92-5.nPerthel M, Kligbeil A, El-Avoubi L, Gerick M, Laas J. 2007. Reduction in blood product usage associated with routine use of mini bypass systems in extracorporeal circulation. Perfusion22:9-14.nRanucci M, Pazzaglia A, Isgro G, et al. 2002. Closed, phosphoryline-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the intraoperative ECMO concept. Int J Artif Organs25:875-81.nRemadi JP, Marticho P, Butoi I, et al. 2004. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg77:2172-6.nRemadi JP, Rakotoarivelo Z, Marticho P, Benamar A. 2006. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra system or with a standard cardiopulmonary bypass. Am Heart J151:198.nShapira OM, Aldea GS, Treanor PR, et al. 1998. Reduction of allogenic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime volume. Ann Thorac Surg65:724-30.nSomer De F, Belleghem Van Y, Caes F, et al. 2002. Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass. J Thorac Cardiovasc Surg123:951-58.nVan Boven WJ, Gerritsen WB, Waanders FG, Haas FJ, Aarts LP. 2004. Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and biochemical results. Perfusion19:239-246.nVon Segesser LK, Tozzi P, Mallbiabrrena I, et al. 2003. Miniaturization in cardiopulmonary bypass. Perfusion18:219-24.nWiesenack C, Liebold A, Phillipp A et al. 2004. Four years experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs28:1082-1088.n



How to Cite

Reber, D., Fritz, M., Tossios, P., Buchwald, D., Lindstaedt, M., Klak, K., Marks, P., & Laczkovics, A. (2008). Beating-Heart Coronary Artery Bypass Grafting Using a Miniaturized Extracorporeal Circulation System. The Heart Surgery Forum, 11(5), E276-E280.