Myocardial revascularization with miniaturized extracorporeal circulation versus off pump: Evaluation of systemic and myocardial inflammatory response in a prospective randomized study

Abstract

Miniaturized extracorporeal circulation can be considered similar to off-pump surgery in terms of systemic inflammatory response, myocardial inflammation and damage, and early outcome.

Advantages to Miniaturized Cardiopulmonary Bypass for Adult Cardiac Surgery

“…Formica [23] demonstrated in a 60 patient randomized study dividing patients to OPCAB and M-CPB similar results between the two groups in terms of systemic inflammatory response mediators (IL-6, TNF-α), myocardial inflammation, and early outcomes. In a comparison of M-CPB with C-CPB and OPCAB, in a small study of 10 patients in each arm, the reduction in red blood damage and activation of coagulation cascades are similar between OPCAB and M-CPB [24].…”

Off-pump Coronary Artery Bypass Does Not Influence Biomarkers of Brain Injury, But Does Exacerbate the Systemic Inflammatory Response

“…Immer et al [22] in an observational cohort were able to demonstrate a reduction in inflammatory markers (including IL-6) using minimal extracorporeal circulation compared to conventional methods. Formica et al [23] reported concentrations in IL-6 were more elevated among patients randomized to OPCAB as opposed to a miniaturized circuit, but they found no difference in TNF-α.…”

Miniaturized Extracorporeal Circulation

“…All components of MECC circuit are pretreated with heparin according to different techniques available on the market. The heparin pre-treatment of the circuit minimizes the systemic heparinization dose requirements (usually half dose of conventional ECC: 150IU/Kg instead of 300IU/Kg) (Curtis et al 2010;Formica et al 2009, Puheler et al 2009Beghi et. 2006) and provides biocompatibility for blood cells (Koivisto et al 2010;Remadi et al 2007;Remadi et al 2004;Fromes et al 2002;) Fig.…”

“…Miniaturized extracorporeal circuit on the left and conventional extracorporeal circulation on the right The tubing length is described to be shorter than conventional ECC in different published reports. Tubing length of about 100 cm is frequently reported as well as a smaller tubing section than conventional ECC tubing (3/8" size instead of 1/2" size) (Formica et al 2009;Mazzei et al 2007). These characteristics lead to a circuit prime volume smaller than standard ECC, ranging between 200-650 ml for the MECC against 1200-1600 ml for the standard ECC (Formica et al 2009Remady et al 2006).…”