Different systems for beating heart procedures and low priming systems limited to coronary artery bypass grafting (CABG) have been introduced. We describe Priming Reduced Extracorporeal Circulation Setup (PRECiSe), a new low priming system which sup-plies all the features of cardiopulmonary bypass (CPB). PRECiSe incorporates the DeltaStream diagonal pump, which pumps blood from the right atrium to the aorta via a membrane oxygenator and a filter; the system is placed beneath the patient's head resulting in extremely short tubing. A reservoir allows the use of suckers and vents. Autologous blood priming furthers reduces hemodilution. In a safety study the system was used for extracorporeal circulation in 11 patients undergoing CABG without adverse effects. By use of PRECiSe mean priming was reduced to 268.5 ml resulting in minimal hemo-dilution and transfusion requirements.
Hemodilution by the crystalloid priming volume of standard heart-lung machines in cardiac surgery is associated with impaired organ function and increased blood transfusion requirements. The aim of this study was to evaluate the effect of the use of the newly developed priming reduced extracorporeal circulation setup (PRECiSe) on perioperative hemodilution and transfusion requirements. In a matched prospective study, 40 patients who underwent operations with the PRECiSe in elective primary coronary artery bypass surgery were compared with 40 patients who underwent operations with the standard heart-lung machine. A significant reduction in final priming volume resulted in a significantly reduced degree of hemodilution and transfusion requirements during and after extracorporeal circulation. In the PRECiSe group, only 10% of the patients needed transfusions during their hospital stay, whereas 35% of the patients in the control group required any transfusion (P < .05). The average transfusion per patient was 0.16 units in the PRECiSe group and 1.25 units in the control group (P < .05). The PRECiSe was demonstrated to be safe and effective in coronary artery bypass surgery with respect to transfusion requirements and hemodilution, as well as with regard to patient safety, as represented by perioperative myocardial performance.
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