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Mini extracorporeal circuit for coronary artery bypass grafting: initial
clinical and biochemical results
WJ van Boven, WB Gerritsen, FG Waanders, FJ Haas and
LP Aarts
St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands;
University Hospital Groningen, Groningen, The Netherlands
| Perfusion 2004; 19: 239-246 |
Background:
The new concept of mini-extracorporeal circulation (MECC) for coronary
artery bypass grafts (MCABG) consists of minimal priming volume, a heparin-coated
closed circuit, a centrifugal pump, active drainage, blood cardioplegia
and a cell-saving device. The potential organ protective effect of this
technique during CABG is unknown. Initial clinical outcomes, oxidative
stress, alveolar shunting and need for blood transfusion were investigated
for MCABG patients. Subsets of these data were compared to outcomes of
matched groups of patients operated conventionally (CCABG) and off-pump
(OPCAB).
Methods:
Data of 184 patients were gathered and analysed from a prospective observational
database system. This database consists of the initial experience with
the first 114 MCABG operations. Of these, the clinical outcome was investigated.
In a subset of 60 MCABGs, need for transfusion was monitored and compared
to 60 CCABGs. Serum concentrations of malondialdehyde (MDA), allantoin/urate
ratios, shunt fractions and lung epithelium-specific proteins (CC16) were
measured as biomarkers of damage during MCABG, CCABG and OPCAB (n=30).
Results:
Patient groupsweresimilar concerning age, risk and number of distal anastomoses.
Clinical outcomes are shown for MCABGs only. During MCABG, need for transfusion
was significantly reduced compared to CCABG (p<0.001). Serum concentrations
of MDA and allantoin/urate ratios showed significantly reduced oxidative
stress during MCABG compared to CCABG. During MCABG, F-shunts were reduced
shortly after surgery. Increased concentrations of pneumoprotein CC16
were measured during CCABG compared to MCABG (data submitted).
Conclusion: Short-term clinical outcomes of MCABG patients
are satisfactory. Compared to CCABG the need for transfusion is significantly
reduced when a MECC is used. Oxidative stress parameters show a tendency
towards improved global organ protection compared to CCABG. F-shunt fractions
and CC16 concentrations suggest reduced alveolar damage during MCABG.
In a prospective study, the protective effect of mini-CABG has to be confirmed.
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