Emergency coronary artery bypass grafting using minimized versus standard extracorporeal circulation – a propensity score analysis

Abstract

BackgroundThe impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial.MethodsA total of 348 patients underwent emergency CABG with MECC (n=146) or conventional extracorporeal circulation (CECC; n=175) between January 2005 and December 2010. Using propensity score matching after binary logistic regression, 100 patients, who underwent CABG with MECC could be matched with 100 patients, who underwent CABG with CECC. Primary outcome was 30-day mortality.ResultsUnadjusted 30-day mortality was 14.8% in patients with CECC and 6.9% in those with MECC (mean difference −7.9%; p=0.03). The adjusted mean difference (average treatment effect of the treated, ATT) after matching was −1.0% (95% CI −8.6 to 7.6; p=1.0). Intensive care unit stay (adjusted mean difference 1.0; 95% CI −0.2 to 3.2; p=0.70) and hospital stay (adjusted mean difference 1.0; 95% CI −2.0 to 3.6; p=0.40) did not show significant differences between both groups. The adjusted mean difference for postoperative low cardiac output syndrome was −1.1% (95% CI −7.3 to 7.1; p=0.83) without significant differences between CECC and MECC. Postoperative mechanical ventilation time, drain loss, postoperative rethoracotomy, postoperative neurological events, new onset renal replacement therapy and respiratory failure also had insignificant average treatment effects of the treated. In addition, all average treatment effects (ATEs) did not significantly differ between both groups.ConclusionUsing propensity score estimation and matching, we did not observe significant differences in terms of survival and further outcomes in patients who undergo emergency CABG with CECC or MECC, but our results call for further analysis.

Conventional or minimized cardiopulmonary bypass support during coronary artery bypass grafting? – An analysis by means of perfusion and body mass index

“…Furthermore, in high‐risk emergency patients, minimized bypass support warrants effective perfusion with at least comparable systemic blood pressure, central venous oxygen saturation, and even lower lactate levels. In a propensity‐matched comparison of conventional and minimized bypass systems in emergency CABG patients from our department, Ried et al reported in 2013 comparable overall and perioperative outcome with regard to postoperative low cardiac output, mechanical ventilation time, drain loss, postoperative re‐thoracotomy, postoperative neurological events, new onset renal replacement therapy and respiratory failure . Our data show the presence of at least comparable or even more effective perfusion, thus indicating protective effects of minimized bypass circuits.…”

Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal circulation

“…It has been proposed that MECC might reduce the harmful effects of CECC, such as systemic inflammatory reaction, hemolysis, hemodilution, disturbances of blood clotting disorders and other postoperative complications. Several authors analyzed the impact of MECC in special patient-cohorts with diabetes, renal insufficiency or in emergent cases [ 9 ]-[ 11 ].…”

Haemostasis and minimally invasive extracorporeal circulation

“…Канюляция восходящей аорты и правого предсердия осуществляется по общепринятой в кардио хирургии методике. Используется венозная двуступенчатая канюля 32/36-32/40 Fr [25,34,41,42] и аортальная канюля 20-24 Fr [25,34,41,43] в соответствии с площадью поверхности тела. Так как объемная скорость перфузии зависит от венозного притока [23], значение имеет корректное положение венозной канюли.…”

“…в течение 10 лет у 2 243 пациентов, оперированных в условиях MiECC с покрытием Bioline, использовали без развития тромботических событий дозу гепарина 125 ед./кг с ВАС 250-300 с [1], схожие результаты отражены в работе M. Ried и соавт. [42].…”

“…При ретроспективном анализе экстренных операций внутрибольничная смертность ниже в группе с MiECC (113 пациентов) 4,4 против 6,8% (74 пациентов) в группе со стандартным искусственным кровообращением (p = 0,48) [10]. Однако следует отметить, что на 30-дневную летальность при экстренных операциях тип используемого ЭКК MiECC не оказывает влияния [42]. По данным исследования F.R.…”