Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery☆

Abstract

Perioperative morbidity of MECC and OPCAB is comparable to or even less in comparison to CCPB. MECC allows CABG surgery in cardiac arrest so that completeness of revascularization is being warranted and longer patency rates can be guaranteed. Furthermore, the use of blood and blood products is significantly less in MECC surgery so that MECC should be considered first choice in CABG surgery over CCPB and OPCAB.

Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures

“…However, the required level of surgical experience in OPCAB revascularization was not well determined in this ROOBY trial which is considered to be a certain drawback of that study. Nevertheless, other reports have also shown a higher number of grafts [10,21,22] and a lower rate of repeat revascularization [27] observed in on-pump patients as compared to OPCAB-operated patients. Correspondingly, in the study by Alamanni et al, OPCAB was identified as the most significant predictor (OR 7,1, 95% CI 5,9-8,3, p < 0,001) of incomplete revascularization [28].…”

“…A considerable number of reports have been published on CABG using ECC and proved that it is a safe and effective treatment of multivessel CAD. However, the standard approach via median sternotomy with the use of cardiopulmonary bypass (CPB) and aortic cross-clamping is associated with certain negative side effects such as systemic inflammatory response syndrome (SIRS) which leads to potentially increased mortality and morbidity [2,10,16-18]. …”

“…The basic idea of Mini-HLM is to ensure adequate perfusion by a closed, extremely minimized circuit based on a rotary blood pump and a high-performance membrane oxygenator with elimination of blood-to-air contact by avoiding a venous reservoir, minimizing hemodilution and mechanical blood trauma and significant reduction of contact activation by reduced foreign surfaces [19]. Meanwhile, a clear superiority of Mini-HLM systems could be proven when compared to conventional CPB circuits [7,9,10,16,20]. …”

“…The relevance of this trend has received considerable attention mainly with regard to minimizing the contact of blood with foreign surfaces [9] and thus reducing or completely avoiding the cardiopulmonary bypass. As a result, there are several less-invasive surgical options for coronary revascularization: either with the use of a minimized extracorporeal circuit (Mini-HLM), in off-pump technique via median sternotomy (OPCAB) or via anterolateral mini-thoracotomy in terms of the MIDCAB (minimally invasive direct coronary artery bypass) approach to the culprit LAD lesion with or without hybrid PTCA of additional coronary lesions [10,11]. Currently, advantages and disadvantages of different approaches are intensively discussed.…”

MECC Equipment

“…A three-stage cannula was introduced in an attempt to overcome the issue of poor venous drainage ( Fig. 4.5 ) [ 21 ] .…”