Is There Really a Clinical Benefit of Using Minimized Extracorporeal Circulation for Coronary Artery Bypass Grafting?

Abstract

A clinical advantage of minimized over standard extracorporeal circulation was not found. Furthermore, a higher number of patients in the minimized extracorporeal circulation group required postoperative norepinephrine infusions for hemodynamic stabilization. In summary, the presumed superiority of minimized extracorporeal circulation for coronary artery bypass grafting in standard patients could not be confirmed.

A prospective randomised multicentre clinical comparison of a minimised perfusion circuit versus conventional cardiopulmonary bypass☆☆☆

“…This was further substantiated by a lack of difference in ICU stay in spite of a shorter postoperative ventilation time. However, one has to note that so far, most studies, including the one presented, have been done on low-risk patients evident by the often observed mortality of 0-2% [5,7,9,22,23].…”

“…Although the positive impact of MPC has been shown in terms of transfusion requirement [5,6,[8][9][10]20], myocardial protection [6][7][8][9]19,20], reduction of platelet consumption [6,8,9] and inflammatory response [2,5,6,21], an overall clinical benefit has been lacking in most publications [2,5,7,9,22,23]. Likewise, with the exception of myocardial infarction, analysis of the postoperative course, including the incidence of major adverse events defined as mortality, major cerebrovascular accidents (four cases of transient postoperative delirium in each group) and re-operation as well as the freedom from adverse events as a whole, has shown no advantage of one bypass circuit over the other.…”

Are minimized perfusion circuits the better heart lung machines? Final results of a prospective randomized multicentre study

“…As most of these studies have enrolled 60 patients or less [3][4][5][6][7] , the lack of evidence to the clinical benefit of MPCs is not surprising.…”

“…In fact, only two 1,2 prospective, randomized studies with a group size of 100 or more have been published. Furthermore, most prospective, randomized studies have concluded that, although MPCs have their benefits in terms of reduction of transfusion requirements or inflammatory reaction, their clinical benefit remains inconclusive [2][3][4][5][6][7][8][9] . As most of these studies included low risk patients with a group size of 30 [3][4][5][6][7] , this lack of clinical evidence is not surprising.…”

Mittelfristiges Outcome kardiochirurgischer Patienten mit einer verlängerten postoperativen Intensivtherapie

“…Einige Arbeitsgruppen sind der An sicht, dies könnte durch den Einsatz mini malisierter HerzLungenMaschinen er reicht werden [11]. Eigene Untersuchun gen mit einer minimalisierten HerzLun genMaschine zeigten jedoch keinen kli nischen Benefit [15]. …”