Minimal Invasive Extracorporeal Circulation (MiECC) in Car-diac Surgery: A Narrative Review

Abstract

The heart remained a mystery for many years and was considered surgically untouchable. With the use of extracorporeal circulation, there has been a revolution in this area. Due to its mechanical components and interactions with blood, cardiopulmonary bypass (CPB) can cause significant changes in the body. Factors such as contact between artificial materials and blood, continuous flow, hemodilution, hypothermia and anticoagulation affect all organs during CPB, and may result in various complications. The minimally invasive extracorporeal circulation (MiECC) system was developed to minimize the contact of blood with air and foreign surfaces during conventional CPB. In addition, the biocompatibility of the components that make up the MiECC circuits increased, which reduced the inflammatory response. The absence of a venous reservoir and shorter lines allow the prime volume to be used to decrease, which also reduces the damage to the blood elements, and consequently, the need for blood transfusion. The MiECC system also has its downsides, the most important one being the difficulty in removing the air that can enter through the venous line, the impairment of the pump function, and embolization. During the use of these systems, perfusion safety and communication with the whole team must be at the highest level. In line with this information, the use of these systems can become standard in cardiac surgery with new technological additions.

Cierre quirúrgico de comunicación interauricular e interventricular sin uso de hemoderivados. Reporte de caso

“…En cirugía cardiaca es una estrategia que ha demostrado reducir el porcentaje de transfusiones sanguíneas. Un metanálisis en el que se incluyeron 31 ensayos aleatorios con 2i282 pacientes, mostró resultados positivos sobre el efecto del recuperador de sangre en su conservación, concluyendo que el uso intraoperatorio redujo la tasa de exposición a cualquier producto sanguíneo alogénico y glóbulos rojos con resultados estadísticamente significativos (OR 0.63 y p=0.02) y que disminuyó el volumen medio de hemoderivados alogénicos totales transfundidos por paciente y que no hubo diferencia en la mortalidad hospitalaria en pacientes con cirugía cardíaca 15,16 .…”

“…Agentes hemostáticos tópicos: los agentes que se emplean para el sellado o compresión anastomótica de heridas, actúan produciendo hemostasia local intentando crear un sello hermético para prevenir el sangrado localizado 16 . Se utilizó el agente hemostático BioGlue® (compuesto de albúmina bovina y glutaraldehído); las moléculas de glutaraldehído se unen covalentemente (reticulan) a las moléculas de albúmina de suero bovino entre sí y estas a las proteínas tisulares en el lugar de la reparación, creando un sello mecánico independiente de la cascada de coagulación 7 .…”