Is minimized extracorporeal circulation effective to reduce the need for red blood cell transfusion in coronary artery bypass grafting? Meta-analysis of randomized controlled trials

Benedetto, Umberto; Angeloni, Emiliano; Refice, Simone; Capuano, Fabio; Goracci, Massimo; Roscitano, Antonino; Sinatra, Riccardo

doi:10.1016/j.jtcvs.2009.03.042

Cited by 32 publications

(15 citation statements)

References 12 publications

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“…In non-emergency patients, MECC was shown to exert some benefit in terms of postoperative renal function, transfusion requirement and neurological dysfunction [27,28]. We failed to show these effects in our matched cohort since new onset RRT and incidence of cerebral event did not differ.…”

Section: Discussionmentioning

confidence: 81%

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

Ried

Haneya

Kolat

et al. 2013

J Cardiothorac Surg

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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.

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Section: Discussionmentioning

confidence: 81%

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

Ried

Haneya

Kolat

et al. 2013

J Cardiothorac Surg

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“…Meanwhile, further randomized studies confirmed that MECC patients need less blood during coronary bypass surgery [13]. One reason is the reduced priming volume of the MECC system and the possibility to maintain a normal hematocrit during the surgical procedure because of the absent venous reservoir and the absent cardiotomy suction.…”

Section: Commentmentioning

confidence: 98%

Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients

Puehler

Haneya

Philipp

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…recently, we and others could demonstrate that MECC patients required less blood products during coronary surgery. 23,32 One reason is the reduced priming volume of this system and the possibility to maintain a normal hematocrit during the surgical procedure because of the absent venous reservoir and the absent cardiotomy suction. In the current analysis, we could demonstrate a reduced rate of blood transfusion with the MECC system.…”

Section: Discussionmentioning

confidence: 99%

Impact of Minimized Extracorporeal Circulation on Outcome in Patients With Preoperative Anemia Undergoing Coronary Artery Bypass Surgery

Haneya¹,

Philipp²,

Suesskind-Schwendi³

et al. 2013

ASAIO Journal

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Preoperative anemia and low hematocrit during cardiopulmonary bypass have been associated with worse outcome in patients undergoing cardiac surgery. The minimized extracorporeal circulation (MECC) allows a reduction of the negative effects associated with conventional extracorporeal circulation (CECC). In this study, the impact of the MECC on outcome of anemic patients after coronary artery bypass grafting (CABG) was assessed. Between January 2004 and December 2011, 1,945 consecutive patients with preoperative anemia underwent isolated CABG using CECC (44.8%) or MECC (55.2%). The cutoff point for anemia was 13 g/dl for men and 12 g/dl for women. The postoperative creatine kinase and lactate levels were significantly lower in the MECC group (p < 0.001). There was no difference in postoperative blood loss between the groups. However, the intraoperative and postoperative transfusion requirements were significantly lower in the MECC group (p < 0.05). Furthermore, MECC patients had lower incidences of postoperative acute renal failure, and low cardiac output syndrome, shorter intensive care unit lengths of stay and reduced 30-day mortality (p < 0.05). In conclusion, a reduced postoperative mortality, lower transfusion requirements, and less renal and myocardial damage encourage the use of MECC for CABG, especially in the specific high-risk subgroup of patients with anemia.

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Is minimized extracorporeal circulation effective to reduce the need for red blood cell transfusion in coronary artery bypass grafting? Meta-analysis of randomized controlled trials

Cited by 32 publications

References 12 publications

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

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

Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients

Impact of Minimized Extracorporeal Circulation on Outcome in Patients With Preoperative Anemia Undergoing Coronary Artery Bypass Surgery

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