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Critical Care

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Open Access 01-04-2007 | Research

Minimally invasive cardiopulmonary bypass: does it really change the outcome?

Authors: Marco Ranucci, Giuseppe Isgrò

Published in: Critical Care | Issue 2/2007

Abstract

Introduction

Many innovative cardiopulmonary bypass (CPB) systems have recently been proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump, and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study aimed to verify the clinical impact of an MICPB in a large population of patients undergoing coronary artery revascularization.

Methods

We conducted a retrospective analysis of 1,663 patients treated with an MICPB. The control group (conventional CPB) was extracted from a series of 2,877 patients according to a propensity score analysis.

Results

Patients receiving an MICPB had a shorter intensive care unit (ICU) stay, had lower peak postoperative serum creatinine and bilirubin levels, and suffered less postoperative blood loss. Within a multivariable model, MICPB is independently associated with lower rates of atrial fibrillation (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69 to 0.99) and ventricular arrhythmias (OR 0.45, 95% CI 0.28 to 0.73) and with higher rates of early discharge from the ICU (OR 1.31, 95% CI 1.06 to 1.6) and from the hospital (OR 1.46, 95% CI 1.18 to 1.8). Hospital mortality did not differ between groups.

Conclusion

MICPBs are associated with reduced morbidity. However, these results will need to be confirmed in a large, prospective, randomized, controlled trial.

Wildevuur CR, Jansen PG, Bezemer PD, Kuik DJ, Eijsman L, Bruins P, De Jong AP, Van Hardevelt FW, Hasenkam JM, Kure HH, et al.: Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits. The European working group on heparin coated extracorporeal circulation circuits. Eur J Cardiothorac Surg 1997, 11: 616-623. 10.1016/S1010-7940(96)01122-0CrossRefPubMed

Ranucci M, Mazzucco A, Pessotto R, Grillone G, Casati V, Porreca L, Maugeri R, Meli M, Magagna P, Cirri S, et al.: Heparin-coated circuits for high-risk patients: a multicenter, prospective, randomized trial. Ann Thorac Surg 1999, 67: 994-1000. 10.1016/S0003-4975(99)00062-4CrossRefPubMed

Øvrum E, Holen EA, Tangen G, Brosstad F, Abdelnoor M, Ringdal MA, Oystese R, Istad R: Completely heparinized cardiopulmonary bypass and reduced systemic heparinization: clinical and hemostatic effects. Ann Thorac Surg 1995, 60: 365-371. 10.1016/0003-4975(95)00366-SCrossRefPubMed

Øvrum E, Tangen G, Schiøtt C, Dragsund S: Rapid recovery protocol applied to 5,658 consecutive 'on pump' coronary bypass patients. Ann Thorac Surg 2000, 70: 2008-2012. 10.1016/S0003-4975(00)01849-XCrossRefPubMed

Aldea GS, Doursounian M, O'Gara P, Treanor P, Shapira M, Lazar HL, Shemin RJ: Heparin-bonded circuits with a reduced anticoagulation protocol in primary CABG: a prospective, randomized study. Ann Thorac Surg 1996, 62: 410-418. 10.1016/0003-4975(96)00249-4CrossRefPubMed

Aldea GS, O'Gara P, Shapira OM, Treanor P, Osman A, Patalis E, Arkin C, Diamone R, Babikian V, Lazar HL, et al.: Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits. Ann Thorac Surg 1998, 65: 425-433. 10.1016/S0003-4975(97)01347-7CrossRefPubMed

Ranucci M, Cazzaniga A, Soro G, Isgrò G, Frigiola A, Menicanti L: Antithrombin III saving effect of reduced systemic heparinization and heparin-coated circuits. J Cardiothorac Vasc Anesth 2002, 16: 316-320. 10.1053/jcan.2002.124140CrossRefPubMed

De Somer F, Francois K, van Oeveren W, Poelaert J, De Wolf D, Ebels T, Van Nooten G: Phosphorylcholine coating of extracorporeal circuits provides natural protection against blood activation by the material surface. Eur J Cardiothorac Surg 2000, 18: 602-606. 10.1016/S1010-7940(00)00508-XCrossRefPubMed

Ranucci M, Pazzaglia A, Isgrò G, Cazzaniga A, Ditta A, Boncilli A, Cotza M, Carboni G, Brozzi S, Bonifazi C: Closed, phosphorylcholine-coated circuit and reduction of systemic heparinization for cardiopulmonary bypass: the intraoperative ECMO concept. Int J Artif Organs 2002, 25: 875-881.PubMed

10.

Ranucci M, Isgrò G, Soro G, Canziani A, Menicanti L, Frigiola A: Reduced systemic heparin dose with phosphorylcholine coated closed circuit in coronary operations. Int J Artif Organs 2004, 27: 311-319.PubMed

11.

Nishida H, Aomi S, Tomizawa Y, Endo M, Koyanagi H, Nojiri G, Oshiyama H, Kido T, Yokoyama K: Comparative study of biocompatibility between the open circuit and closed circuit in cardiopulmonary bypass. Artif Organs 1999, 23: 547-551. 10.1046/j.1525-1594.1999.06401.xCrossRefPubMed

12.

Takai H, Eishi K, Yamachika S, Hazama S, Nishi K, Ariyoshi T, Nakaji S, Matsumaru I: The efficacy of low prime volume completely closed cardiopulmonary bypass in coronary artery revascularization. Ann Thorac Cardiovasc Surg 2004, 10: 178-182.PubMed

13.

Ranucci M, Pavesi M, Mazza E, Bertucci C, Frigiola A, Menicanti L, Ditta A, Boncilli A, Conti D: Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 1994, 9: 319-326.CrossRefPubMed

14.

Ranucci M, Romitti F, Isgrò G, Cotza M, Brozzi S, Boncilli A, Ditta A: Oxygen delivery during cardiopulmonary bypass and acute renal failure following coronary operations. Ann Thorac Surg 2005, 80: 2213-2220. 10.1016/j.athoracsur.2005.05.069CrossRefPubMed

15.

Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A: Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg 2003, 125: 1438-1450. 10.1016/S0022-5223(02)73291-1CrossRefPubMed

16.

Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M: The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg 2003, 76: 784-792. 10.1016/S0003-4975(03)00558-7CrossRefPubMed

17.

Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, Djaiani G, Ivanov J, Karski J, David TE: Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005, 129: 391-400. 10.1016/j.jtcvs.2004.06.028CrossRefPubMed

18.

Immer FF, Pirovino G, Gygax E, Englberger L, Tevaearai H, Carrel TP: Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg 2005, 28: 701-704. 10.1016/j.ejcts.2005.08.019CrossRefPubMed

19.

Wippermann J, Albes JM, Hartrumpf M, Kaluza M, Vollandt R, Bruhin R, Wahlers T: Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system. Eur J Cardiothorac Surg 2005, 28: 127-132. 10.1016/j.ejcts.2005.03.032CrossRefPubMed

20.

Huybregts MA, de Vroege R, Christiaans HM, Smith AL, Paulus RC: The use of a mini bypass system (Cobe Synergy) without venous and cardiotomy reservoir in a mitral valve repair: a case report. Perfusion 2005, 20: 121-124. 10.1191/0267659105pf794crCrossRefPubMed

21.

Fayad G, Modine T, Naja G, Larrue B, Azzaoui R, Crepin F, Decoene C, Benhamed L, Koussa M, Gourlay T, et al.: Second generation of minimal invasive extracorporeal circuit: pilot study resting heart system. J Extra Corpor Technol 2005, 37: 387-389.PubMed

22.

Ranucci M, Bellucci C, Conti D, Cazzaniga A, Maugeri B: Determinants of early discharge from the intensive care unit after cardiac operations. Ann Thorac Surg 2007, 83: 1089-1095. 10.1016/j.athoracsur.2006.10.003CrossRefPubMed

23.

Nollert G, Schwabenland I, Maktav D, Kur F, Christ F, Fraunberger P, Reichart B, Vicol C: Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammation and coagulation but loss of safety margins. Ann Thorac Surg 2005, 80: 2326-2332. 10.1016/j.athoracsur.2005.05.080CrossRefPubMed

24.

Myles PS, Gin T, (Eds): Statistical Methods for Anaesthesia and Intensive Care. Oxford: Butterworth-Heinemann; 2000.

25.

Remadi JP, Marticho P, Butoi I, Rakotoarivello Z, Trojette F, Benamar A, Beloucif S, Foure D, Poulain HJ: Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg 2004, 77: 2172-2175. 10.1016/S0003-4975(03)00977-9CrossRefPubMed

26.

Remadi JP, Rakotoarivello Z, Marticho P, Trojette F, Benamar A, Poulain HJ, Tribouilloy C: Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial. J Thorac Cardiovasc Surg 2004, 128: 436-441. 10.1016/j.jtcvs.2004.01.041CrossRefPubMed

27.

Remadi JP, Rakotoarivello Z, Marticho P, Benamar A: Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J 2006, 151: 198. 10.1016/j.ahj.2005.03.067CrossRefPubMed

28.

Beghi C, Nicolini F, Agostinelli A, Borrello B, Budillon AM, Bacciottini F, Figgeri M, Costa A, Belli L, Battistelli L, et al.: Mini-cardiopulmonary bypass system: results of a prospective randomized study. Ann Thorac Surg 2006, 81: 1396-1400. 10.1016/j.athoracsur.2005.10.015CrossRefPubMed

29.

Hogue CW Jr, Creswell LL, Gutterman DD, Fleisher LA, American College of Chest Physicians: Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005, 128: 9S-16S. 10.1378/chest.128.2_suppl.9SCrossRefPubMed

30.

Fontes ML, Mathew JP, Rinder HM, Zelterman D, Smith BR, Rinder CS, Multicenter Study of Perioperative Ischemia (McSPI) Research Group: Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation. Anesth Analg 2005, 101: 17-23. 10.1213/01.ANE.0000155260.93406.29CrossRefPubMed

31.

Lamm G, Auer J, Weber T, Berent R, Ng C, Eber B: Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth 2006, 20: 51-56. 10.1053/j.jvca.2005.03.026CrossRefPubMed

32.

Aldea GS, Soltow LO, Chandler WL, Triggs CM, Vocelka CR, Crockett GI, Shin YT, Curtis WE, Verrier ED: Limitation of thrombin generation, platelet activation, and inflammation by elimination of cardiotomy suction in patients undergoing coronary artery bypass grafting treated with heparin-bonded circuits. J Thorac Cardiovasc Surg 2002, 123: 742-755. 10.1067/mtc.2002.120347CrossRefPubMed

Title: Minimally invasive cardiopulmonary bypass: does it really change the outcome?
Authors: Marco Ranucci
Giuseppe Isgrò
Publication date: 01-04-2007
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2007
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc5777

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Minimally invasive cardiopulmonary bypass: does it really change the outcome?

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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