Minimal Extracorporeal Circulation: An Alternative for On-Pump and Off-Pump Coronary Revascularization

Puehler, Thomas; Haneya, Assad; Philipp, Alois; Wiebe, Karsten; Keyser, Andreas; Rupprecht, Leopold; Hirt, Stephan; Kobuch, Reinhard; Diez, Claudius; Hilker, Michael; Schmid, Çhristof

doi:10.1016/j.athoracsur.2008.11.050

Cited by 62 publications

(48 citation statements)

References 28 publications

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“…Furthermore, CK levels after MECC procedure were lower as compared with ECC procedures, indicating less myocardial damage and better organ and tissue perfusion as described by Puehler et al [13].…”

Section: Discussionmentioning

confidence: 50%

Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients

Haneya¹,

Philipp²,

Schmid³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 50%

Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients

Haneya¹,

Philipp²,

Schmid³

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Therefore, performing OPCAB in every single patient who seems to be a candidate for surgical myocardial revascularisation for the sole purpose of attracting more patients or due to other political and economic pressures may not be appropriate and economically hazardous [38]. With regard to the increasing overall excellent experience with Mini-HLM worldwide [39,40], OPCAB should be restricted to carefully selected special cases, i.e. patients presenting with severely calcified aorta etc..…”

Section: Resultsmentioning

confidence: 99%

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Wittwer

Choi

Neef

et al. 2011

J Cardiothorac Surg

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BackgroundOff-pump-coronary-artery-bypass-grafting (OPCAB) and minimized-extracorporeal-circulation (Mini-HLM) have been proposed to avoid harmful effects of cardiopulmonary-bypass (CPB). Controversies exist whether OPCAB is still superior in perioperative outcome. Circulating endothelial cells (CEC) are sensitive markers of endothelial damage and are significantly elevated in conventional-CPB-procedures as compared to Mini-HLM-revascularisation. Therefore, CEC might be of specific value in evaluating effectiveness of Mini-HLM and OPCAB as currently applied less-invasive coronary procedures.Methods76 coronary patients were randomly assigned either to OPCAB (n = 34) or to Mini-HLM (ROCsafe™, Terumo Inc., n = 42) procedures. Perioperative data, clinical and serological outcome and measurements of CEC-release and parameters of endothelial function (v.Willebrand-Factor, soluble-thrombomodulin) perioperatively (pre-operative-baseline, post-Mini-HLM/release of OPCAB-stabilizer, 6 h, 12 h, 24 h and 5 days postoperatively) were obtained and compared by ANOVA models including repeated-measures-analysis.ResultsMean graft-number was 3.06 ± 0.72 in Mini-HLM-patients and 1.89 ± 0.74 in OPCAB-patients (p < 0.001). However, ventilation-, ICU- and total-hospital duration were comparable between groups as well as chest-tube-drainage, transfusion requirements, hemodynamics and catecholaminergic support (p > 0.05). CEC-release did not differ between groups (p = 0.274) and was generally within normal limits, Troponin-T levels where not significanty different (p = 0.108). No myocardial infarctions, strokes or deaths occurred, neuron specific enolase (NSE) did not show any differences between groups (p = 0.194).ConclusionConceptional advantages of minimized CPB systems (ROCsafe™) result in morbidity and mortality comparable with OPCAB procedures. Mini-HLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in high-risk patients while facilitating more complete revascularization in complex patients.

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“…more aggressive use of antithrombotic and antiplatelet agents to prevent thromboembolism [14] for these patients. Surgical techniques may also need modification to eliminate the risk of atheroembolism, such as off-pump, or minimal extracorporeal circulation CABG [32].…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

Predictors associated with stroke after coronary artery bypass grafting: A systematic review

Mao

Zhong

Yin

et al. 2015

Journal of the Neurological Sciences

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Minimal Extracorporeal Circulation: An Alternative for On-Pump and Off-Pump Coronary Revascularization

Cited by 62 publications

References 28 publications

Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients

Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients

Off-pump or minimized on-pump coronary surgery - initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Predictors associated with stroke after coronary artery bypass grafting: A systematic review

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