WJCS  Vol.4 No.12 , December 2014
Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting
ABSTRACT
The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%, with none occurring in the MCPBC group. The MCPBC group required less PRBC and total blood product transfusion than the cCABG and OPCABG groups (p = 0.05), but changes in PLT and Hct over time were not different between groups. Conclusions: The MCPBC system was shown to be comparable to conventional bypass and OPCABG in terms of postoperative complications and mortality. Furthermore, the MCPBC system had the advantage of a decreased transfusion requirement. Based on our preliminary observations, this mini-cardiopulmonary bypass circuit provides a safe alternative to conventional bypass techniques.

Cite this paper
Emerson, D. , Baldwin, D. , Pinales, M. , Greenberg, M. , Mattes, M. and Trachiotis, G. (2014) Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting. World Journal of Cardiovascular Surgery, 4, 232-238. doi: 10.4236/wjcs.2014.412034.
References
[1]   Gibbon Jr., J.H. (1954) Application of a Mechanical Heart and Lung Apparatus to Cardiac Surgery. Minnesota Medicine, 37, 171-185.

[2]   Edwards, F.H., Clark, R.E. and Schwartz, M. (1994) Coronary Artery Bypass Grafting: The Society of Thoracic Surgeons National Database Experience. The Annals of Thoracic Surgery, 57, 12-19.
http://dx.doi.org/10.1016/0003-4975(94)90358-1

[3]   Fitzgibbon, G.M., Kafka, H.P., Leach, A.J., Keon, W.J., Hooper, G.D. and Burton, J.R. (1996) Coronary Bypass Graft Fate and Patient Outcome: Angiographic Follow-Up of 5,065 Grafts Related to Survival and Reoperation in 1,388 Patients during 25 Years. Journal of the American College of Cardiology, 28, 616-626.
http://dx.doi.org/10.1016/0735-1097(96)00206-9

[4]   Liebold, A., Keyl, C. and Birnbaum, D.E. (1999) The Heart Produces but the Lungs Consume Proinflammatory Cytokines Following Cardiopulmonary Bypass. European Journal Cardio-Thoracic Surgery, 15, 340-345.
http://dx.doi.org/10.1016/S1010-7940(99)00038-X

[5]   Wendel, H.P. and Ziemer, G. (1999) Coating-Techniques to Improve the Hemocompatibility of Artificial Devices Used for Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 16, 342-350.
http://dx.doi.org/10.1016/S1010-7940(99)00210-9

[6]   Kirklin, J.K., Westaby, S., Blackstone, E.H., Kirklin, J.W., Chenoweth, D.E. and Pacifico, A.D. (1983) Complement and the Damaging Effects of Cardiopulmonary Bypass. The Journal of Thoracic and Cardiovascular Surgery, 86, 845-857.

[7]   Paparella, D., Yau, T.M. and Young, E. (2002) Cardiopulmonary Bypass Induced Inflammation: Pathophysiology and Treatment. An Update. European Journal Cardio-Thoracic Surgery, 21, 232-244.
http://dx.doi.org/10.1016/S1010-7940(01)01099-5

[8]   Puskas, J.D. and Steele, M. (2007) Would You Like Some Cardiopulmonary Bypass with your Coronary Revascularization? Circulation, 116, 1756-1758.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.733089

[9]   Wiesenack, C., Liebold, A., Philipp, A., Ritzka, M., Koppenberg, J., Birnbaum, D.E. and Keyl, C. (2004) Four Years’ Experience with a Miniaturized Extracorporeal Circulation System and Its Influence on Clinical Outcome. Artificial Organs, 28, 1082-1088.
http://dx.doi.org/10.1111/j.1525-1594.2004.00030.x

[10]   Sakwa, M.P., Emery, R.W., Shannon, F.L., Altshuler, J.M., Mitchell, D., Zwada, D. and Holter, A.R. (2009) Coronary Artery Bypass Grafting with a Minimized Cardiopulmonary Bypass Circuit: A Prospective, Randomized Trial. The Journal of Thoracic and Cardiovascular Surgery, 137, 481-485.
http://dx.doi.org/10.1016/j.jtcvs.2008.08.057

[11]   Remadi, J.P., Marticho, P., Butoi, I., Rakotoarivelo, Z., Trojette, F., Benamar, A., Beloucif, S., Foure, D. and Poulain, H.J. (2004) Clinical Experience with the Mini-Extracorporeal Circulation System: An Evolution or a Revolution? The Annals of Thoracic Surgery, 77, 2172-2175.
http://dx.doi.org/10.1016/S0003-4975(03)00977-9

[12]   Liebold, A., Khosravi, A., Westphal, B., Skrabal, C., Choi, Y.H., Stamm, C., Kaminski, A., Alms, A., Birken, T., Zurakowski, D. and Steinhoff, G. (2006) Effect of Closed Minimized Cardiopulmonary Bypass on Cerebral Tissue Oxygenation and Microembolization. The Journal of Thoracic and Cardiovascular Surgery, 131, 268-276.
http://dx.doi.org/10.1016/j.jtcvs.2005.09.023

[13]   Abdel-Rahman, U., Ozaslan, F., Risteski, P.S., Martens, S., Moritz, A., Al Daraghmeh, A., Keller, H. and Wimmer-Greinecker, G. (2005) Initial Experience with a Minimized Extracorporeal Bypass System: Is There a Clinical Benefit? The Annals of Thoracic Surgery, 80, 238-243.
http://dx.doi.org/10.1016/j.athoracsur.2005.02.032

[14]   Beghi, C., Nicolini, F., Agostinelli, A., Borrello, B., Budillon, A.M., Bacciottini, F., Friggeri, M., Costa, A., Belli, L., Battistelli, L. and Gherli, T. (2006) Mini-Cardiopulmonary Bypass System: Results of a Prospective Randomized Study. The Annals of Thoracic Surgery, 81, 1396-400.
http://dx.doi.org/10.1016/j.athoracsur.2005.10.015

[15]   Balachandran, S., Cross, M.H., Karthikeyan, S., Mulpur, A., Hansbro, S.D. and Hobson, P. (2002) Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit Reduces Blood Transfusion after Coronary Artery Surgery. The Annals of Thoracic Surgery, 73, 1912-1918.
http://dx.doi.org/10.1016/S0003-4975(02)03513-0

[16]   Hsu, L.C. (1997) Biocompatibility in Cardiopulmonary Bypass. Journal of Cardiothoracic and Vascular Anesthesia, 11, 376-382.
http://dx.doi.org/10.1016/S1053-0770(97)90108-7

[17]   Palatianos, G.M., Foroulis, C.N., Vassili, M.I., Astras, G., Triantafillou, K., Papadakis, E., Lidoriki, A.A., Iliopoulou, E. and Melissari, E.N. (2003) A Prospective, Double-Blind Study on the Efficacy of the Bioline Surface-Heparinized Extracorporeal Perfusion Circuit. The Annals of Thoracic Surgery, 76, 129-135.
http://dx.doi.org/10.1016/S0003-4975(03)00338-2

[18]   Ovrum, E., Mollnes, T.E., Fosse, E., Holen, E.A., Tangen, G., Abdelnoor, M., Ringdal, M.A., Oystese, R. and Venge, P. (1995) Complement and Granulocyte Activation in Two Different Types of Heparinized Extracorporeal Circuits. The Journal of Thoracic and Cardiovascular Surgery, 110, 1623-1632.
http://dx.doi.org/10.1016/S0022-5223(95)70023-4

[19]   Fromes, Y., Gaillard, D., Ponzio, O., Chauffert, M., Gerhardt, M.F., Deleuze, P. and Bical, O.M. (2002) Reduction of the Inflammatory Response Following Coronary Bypass Grafting with Total Minimal Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 22, 527-533.
http://dx.doi.org/10.1016/S1010-7940(02)00372-X

[20]   Koch, C.G., Li, L., Duncan, A.I., Mihaljevic, T., Cosgrove, D.M., Loop, F.D., Starr, N.J. and Blackstone, E.H. (2006) Morbidity and Mortality Risk Associated with Red Blood Cell and Blood-Component Transfusion in Isolated Coronary Artery Bypass Grafting. Critical Care Medicine, 34, 1608-1616.
http://dx.doi.org/10.1097/01.CCM.0000217920.48559.D8

[21]   Koch, C.G., Li, L., Duncan, A.I., Mihaljevic, T., Loop, F.D., Starr, N.J. and Blackstone, E.H. (2006) Transfusion in Coronary Artery Bypass Grafting Is Associated with Reduced Long-Term Survival. The Annals of Thoracic Surgery, 81, 1650-1657.
http://dx.doi.org/10.1016/j.athoracsur.2005.12.037

[22]   Fromes, Y., Gaillard, D., Ponzio, O., Chauffert, M., Gerhardt, M.F., Deleuze, P. and Bical, O.M. (2002) Reduction of the Inflammatory Response Following Coronary Bypass Grafting with Total Minimal Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 22, 527-533.
http://dx.doi.org/10.1016/S1010-7940(02)00372-X

[23]   Harling, L., Warren, O.J., Martin, A., Kemp, P.R., Evans, P.C., Darzi, A. and Athanasiou, T. (2011) Do Miniaturized Extracorporeal Circuits Confer Significant Clinical Benefit without Compromising Safety? A Meta-Analysis of Randomized Controlled Trials. ASAIO Journal, 57, 141-151.
http://dx.doi.org/10.1097/MAT.0b013e318209d63b

[24]   Formica, F., Broccolo, F., Martino, A., Sciucchetti, J., Giordano, V., Avalli, L., Radaelli, G., Ferro, O., Corti, F., Cocuzza, C. and Paolini, G. (2009) Myocardial Revascularization with Miniaturized Extracorporeal Circulation versus Off Pump: Evaluation of Systemic and Myocardial Inflammatory Response in a Prospective Randomized Study. The Journal of Thoracic and Cardiovascular Surgery, 137, 1206-1212.
http://dx.doi.org/10.1016/j.jtcvs.2008.09.074

 
 
Top