A comparison between minimized extracorporeal circuits and conventional extracorporeal circuits in patients undergoing aortic valve surgery: is ‘minimally invasive extracorporeal circulation’ just low prime or closed loop perfusion ?

Starinieri, Pascal; Declercq, Peter; Robic, Boris; Yilmaz, Alaaddin; Tornout, Michiel Van; Dubois, Jasperina; Mees, Urbain; Hendrikx, Marc

doi:10.1177/0267659117691814

Cited by 13 publications

(12 citation statements)

References 16 publications

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“…Overall, the majority of the clinical studies confirm the hypothesis that MiECC induces less inflammatory activation than standard CPB, even if different results were observed in other studies (41)(42)(43).…”

Section: Inflammatory Reaction During Standard Cpb and Mieccsupporting

confidence: 62%

Inflammation and coagulation following minimally invasive extracorporeal circulation technologies

Ranucci

Baryshnikova

2019

J. Thorac. Dis

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Minimally invasive extracorporeal perfusion technologies are based on the use of a minimally invasive extracorporeal circulation (MiECC) system. This includes a closed CPB circuit; biologically inert blood contact surfaces; reduced priming volume; a centrifugal pump; a membrane oxygenator; a heat exchanger; a cardioplegia system; a venous bubble trap/venous air removing device; and a shed blood management system. Some of these items, alone or in combination, are able to modify the blood activation usually elicited by cardiopulmonary bypass (CPB). The hemostatic system activation is less activated and lower degrees of thrombin generation and platelet activation have been found in numerous studies.Additionally, the reduced level of hemodilution plays an important role in preserving clot firmness after CPB with MiECC. These biochemical changes are reflected by a blood loss containment, a reduced need for allogeneic blood transfusions, and, in some studies, by a lower thromboembolic complications rate. The activation of the inflammatory cascade is in turn limited by MiECC, both directly (through a blunting of the contact-phase activation) and indirectly (through a limited thrombin generation, platelet activation, and consequent lower release of pro-inflammatory cytokines). The clinical consequences of this are mainly demonstrated by a lower rate of postoperative atrial fibrillation; other inflammation-derived outcomes appear favorably affected by MiECC (lung function, acute kidney injury) but the multi-factorial nature of these complications makes difficult to clearly attribute this pattern to a lower degree of inflammation. Overall, the existing body of evidence is in favor of MiECC with respect to standard CPB.

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Section: Inflammatory Reaction During Standard Cpb and Mieccsupporting

confidence: 62%

Inflammation and coagulation following minimally invasive extracorporeal circulation technologies

Ranucci

Baryshnikova

2019

J. Thorac. Dis

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“…Cardiopulmonary bypass (CPB) is performed using a minimally invasive ECC system [the mini-Inspire JESSA MiECC (Sorin S.p.A., Mirandola, Italy)]. This technique has been reported in Perfusion [12]. Patients undergoing single vessel LIMA-LAD are also placed on MiECC CPB to decompress the heart but do not receive cardioplegia.…”

Section: Endo-cabg: Description Of Operative Techniquementioning

confidence: 99%

A new viewpoint on endoscopic CABG: technique description and clinical experience

Yilmaz

Robic

Starinieri

et al. 2020

Journal of Cardiology

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Coronary artery bypass graft (CABG) remains the standard of care for patients with multi-vessel coronary artery disease [1]. Although traditional CABG is performed via median sternotomy, this surgical access route is associated with major disadvantages such as a prolonged recovery time, a poor cosmetic result, and a significant risk of chronic post-sternotomy pain, as well as several potential complications, including sternal instability, delayed bone healing, and wound infections [2]. Diabetes, obesity, and large breast size in females are important risk factors for sternal wound complications and therefore relative contraindications for bilateral internal mammary artery (BIMA) grafting via classic sternotomy. To overcome these restrictions, less invasive access routes to the heart, including mini-thoracotomy or partial opening of the sternum have been investigated since the mid-1990s. During the past decade, these minimally invasive procedures have increased in popularity, are more commonly applied, and have even become the routine method in several centers around the world [3]. They are proven to be safe and feasible [4] with excellent surgical outcomes, including a reduced patient recovery time [5], lower transfusion rates, less wound infections, shorter hospitalization time, and low hospital mortality rate [6].

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“…1. аортокоронарное шунтирование [8][9][10]; 2. протезирование аортального клапана [8,[10][11][12][13][14][15][16][17][18]; 3. пластика митрального клапана [17]; 4. реконструктивная операция на грудной и брюшной аорте [17,18]; 5. имплантация вспомогательного устройства левого желудочка (LVAD) [19]; 6. Fast Track протокол [16,20].…”

Section: показания к использованию систем Mieccunclassified

Haemostasis and minimally invasive extracorporeal circulation

Kornev¹,

Шелухин²

2019

PKiK

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Advances in extracorporeal circulation using a minimally invasive circuit have rapidly emerged, and the components and biocoatings of the minimally invasive extracorporeal circuit (MiECC) have improved. The application range of minimally invasive cardiopulmonary bypass has expanded, however the main indications for the use of MiECCs during cardiac surgery have not yet been systematized. To the best of our knowledge, no guidelines for anticoagulant therapy regimens during minimally invasive cardiopulmonary bypass exist, and its effect on blood loss and the activation of coagulation in the perioperative period remain unclear. The present review highlighted the components of the circuit and the practical aspects of using MiECC. We formulated indications for the use of minimally invasive circuits and classified biocompatible coatings used to reduce the contact activation of haemostasis. According to the literature, when performing cardiopulmonary bypass with MiECC, the physiological haemostatic balance is disturbed. The detected changes in plasma haemostasis do not allow drawing conclusions regarding the advantages of MiECC, despite its clinical benefits. Multicentre randomized trials that comply with the rules of the pre-analytical stage of haemostasis and use global tests (thrombin generation test, thrombodynamics test, etc.) are required. The available studies on the haemostatic system using MiECC are not adequate for determining whether MiECCs on a haemostatic system are recommendable. However, MiECCs allow physicians to get closer to the fast track cardiac surgery ideal.Received 7 October 2019. Revised 14 November 2019. Accepted 18 November 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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A comparison between minimized extracorporeal circuits and conventional extracorporeal circuits in patients undergoing aortic valve surgery: is ‘minimally invasive extracorporeal circulation’ just low prime or closed loop perfusion ?

Abstract: MiECC provides circulatory support that is equally safe and feasible as conventional extracorporeal circuits. No differences in mortality, hospital stay or inflammation markers were observed.

Cited by 13 publications

References 16 publications

Inflammation and coagulation following minimally invasive extracorporeal circulation technologies

Inflammation and coagulation following minimally invasive extracorporeal circulation technologies

A new viewpoint on endoscopic CABG: technique description and clinical experience

Haemostasis and minimally invasive extracorporeal circulation

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