Minimal extracorporeal circulation: An appraisal from a private practice

Abstract

INTRODUCTION Cardiopulmonary bypass (CPB) and cardiac arrest allow the surgeon to perform controlled anastomoses during coronary artery bypass graft surgery (CABG). However, this comes at a cost. A systemic inflammatory response is a risk for organ damage and thus mortality and morbidity. Beating heart surgery, or off-pump CABG (OPCAB), was reintroduced to attenuate this effect. Many studies demonstrated very optimistic results in favour of OPCAB compared to CABG with conventional CPB. However, not everybody is convinced by the benefits, and this was addressed in a review on whether it would be beneficial to change to OPCAB. (1) In this study, the combined prevalence of mortality, myocardial infarction, stroke and new dialysis was 4%. To improve this with even 25% would require 10 600 patients, which is impossible in the average private cardiac practice in South Africa. Many randomised controlled studies could not demonstrate clear benefits and surgeons are losing interest in the OPCAB technique. (2) This is confirmed by a review from the Cochrane Libraries. Based on the current evidence, CABG should be done with conventional CPB. (3)