Enhanced Recovery After Elective Coronary Revascularization Surgery With Minimal Versus Conventional Extracorporeal Circulation: A Prospective Randomized Study

Anastasiadis, Kyriakos; Asteriou, Christos; Antonitsis, Polychronis; Argiriadou, Helena; Grosomanidis, Vasilios; Kyparissa, M.; Deliopoulos, Apostolos; Konstantinou, Dimitrios; Tossios, Paschalis

doi:10.1053/j.jvca.2013.01.010

Cited by 34 publications

(19 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies have shown that MiECC seems to alleviate CECC-related effects in terms of inflammatory reactions (2,3,6,(9)(10)(11). Furthermore, studies observed a reduced incidence of postoperative atrial fibrillation (2,12), lower troponin levels (13,14), less need for transfusions (15,16), a shorter stay on the intensive care unit (17,18), and a more preserved neurocognitive function (19)(20)(21).…”

mentioning

confidence: 99%

Type II Minimal‐Invasive Extracorporeal Circuit for Aortic Valve Replacement: A Randomized Controlled Trial

Gygax

Stalder

et al. 2018

Artificial Organs

View full text Add to dashboard Cite

Extracorporeal circulation triggers systemic inflammatory response and coagulation disorders which may lead to unfavorable clinical outcome. A type II minimally-invasive extracorporeal circuit (MiECC) is a closed system with markedly reduced artificial surface as compared to conventional extracorporeal circuits (CECC). The aim of this study was to investigate and compare inflammatory responses, complement activation and selected clinical end-points in isolated surgical aortic valve replacement (SAVR) performed with a type II MiECC circuit or a CECC. Fifty patients were prospectively randomized to MiECC or CECC perfusion regimen. Complement activation (sC5b-9), inflammation (IL-6, TNF-α, sCD40-ligand) and activation of the coagulation system (D-dimer, TAT-complex) were determined before operation, at 2 hours and 24 hours after surgery. Clinical end-points included perfusion time, transfusion of allogeneic blood products, postoperative bleeding, sepsis, new onset of atrial fibrillation, stroke and in-hospital mortality. Patient characteristics and baseline plasma markers were similar in both groups. Levels for sC5b-9, TNF-α, sCD40 ligand, TAT-complex and D-dimers were not significantly different between MiECC and CECC at 2 hours and 24 hours after surgery. The IL-6 plasma concentration was lower in the CECC group at 24 hours (P = 0.026, vs. MiECC). Comparisons of the baseline level to values at 2 hours and 24 hours, adjusted for the type of oxygenator and hemoglobin, showed a significantly lower sC5b-9 in MiECC at 2 hours (P = 0.013), but no difference at 24 hours (P=0.990). Compared with CECC, MiECC patients had a shorter perfusion time (P = 0.037) and less transfusion requirements (P = 0.04). In this selected cohort of SAVR patients, the type II MiECC was not inferior to CECC in terms of inflammatory response and complement activation. Thus, MiECC might be an alternative perfusion strategy to conventional.

show abstract

mentioning

confidence: 99%

Type II Minimal‐Invasive Extracorporeal Circuit for Aortic Valve Replacement: A Randomized Controlled Trial

Gygax

Stalder

et al. 2018

Artificial Organs

View full text Add to dashboard Cite

show abstract

“…In contrast, Anastasiadis et al reported in their large meta‐analysis of 24 studies and c. 2800 patients that MiECC reduced the occurrence of POAF from 27.6% to 19.2% 20 . Correspondingly, of the four randomized trials comparing MiECC and CECC, two reported that MiECC was associated with 33%‐38% reduction in the development of POAF 21,22 . In the study by El‐Essawi, the incidence of POAF reduced from 24.2% to 16.3%, and in the study by Anastasiadis from 53.3% to 33.3%.…”

Section: Discussionmentioning

confidence: 88%

“…In our study, as well as in all the aforementioned studies patients undergoing CABG with no additional surgery were studied. In spite of this, the incidence of POAF in the reference group (CECC) has ranged considerably, from 19% to 53% 17,21‐24 . This most probably depicts different definition of POAF used in these trials.…”

Section: Discussionmentioning

confidence: 96%

Impact of minimal invasive extracorporeal circulation on atrial fibrillation after coronary artery bypass surgery

et al. 2020

View full text Add to dashboard Cite

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with an incidence between 15% and 50% and pathophysiology not fully known. By choosing the method of extracorporeal circulation with focus on the reduction of systemic inflammatory response, one can potentially decrease the risk of POAF. In this prospective, randomized trial, we compared minimal invasive extracorporeal circulation (MiECC) with conventional extracorporeal circulation (CECC) in the prevention of POAF after coronary artery bypass surgery (CABG). A total of 240 patients who were scheduled for their first on‐pump CABG, were randomized to MiECC or CECC. The primary outcome measure was the incidence of first POAF during the first 84 hours after surgery. POAF occurred in 42/120 (35.0%) MiECC patients and 43/120 (35.8%) CECC patients with nonsignificant difference between the groups (OR 1.043, 95% CI 0.591‐1.843, P = .884). The first postoperative creatine kinase‐MB mass (CK‐MBm) value was lower in the MiECC group, 13.95 [10.5‐16.7] (median [IQR]) than in the CECC group, 15.30 [11.4‐18.9] (P = .036), whereas the use of perioperative dobutamine was higher in the MiECC group, 18/120 (15.0%), than in the CECC group 8/120 (6.7%) (P = .038). The incidence of a stroke, perioperative myocardial infarction, and resternotomy caused by bleeding did not differ in the MiECC and CECC groups. Age (OR 1.08, 95% CI 1.04‐1.13, P = .000) and peak postoperative CK‐MBm (OR 1.57, 95% CI 1.06‐2.37, P = .026) were independent predictors of POAF. MiECC compared to CECC was not effective in reducing the incidence of POAF in patients undergoing CABG.

show abstract

“…Avoidance of blood transfusion as well as the biocompatible design of MiECC circuit with elimination of blood‐air interaction contributes to preservation of microvascular perfusion that ultimately leads to improved end‐organ protection during CPB . This could explain reduced duration of mechanical ventilation and need for ICU stay as well as the lower cumulative incidence of major adverse events observed in our study . Regression analysis quantified this beneficial effect to 50 cases performed with MiECC, which was also empirically determined by other investigators .…”

Section: Discussionmentioning

confidence: 99%

Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation

et al. 2016

Self Cite

View full text Add to dashboard Cite

Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P <0.001), peak troponin release (0.07 ± 0.02 vs. 0.1 ± 0.04 ng/mL, P < 0.01), peak creatinine levels (0.97 ± 0.24 vs. 1.2 ± 0.3 mg/dL, P < 0.001), duration of mechanical ventilation (14.1 ± 7.2 vs. 36.9 ± 59.8 h, P < 0.01) and ICU stay (2.1 ± 0.7 vs. 4.4 ± 6.4 days, P < 0.01). However, need for intraoperative blood transfusion showed a trend towards a gradual decrease as experience with MiECC system was accumulating (R = 0.094, P = 0.007). Subsequently, operational learning applied to postoperative hematocrit and hemoglobin levels (R = 0.098, P = 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology.

show abstract

Enhanced Recovery After Elective Coronary Revascularization Surgery With Minimal Versus Conventional Extracorporeal Circulation: A Prospective Randomized Study

Cited by 34 publications

References 28 publications

Type II Minimal‐Invasive Extracorporeal Circuit for Aortic Valve Replacement: A Randomized Controlled Trial

Type II Minimal‐Invasive Extracorporeal Circuit for Aortic Valve Replacement: A Randomized Controlled Trial

Impact of minimal invasive extracorporeal circulation on atrial fibrillation after coronary artery bypass surgery

Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation

Contact Info

Product

Resources

About