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Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients

^a Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
^b Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany

Received 13 November 2008; received in revised form 15 April 2009; accepted 25 May 2009.

^_* Corresponding author. Address: University Medical Center Regensburg, Department of Cardiothoracic Surgery, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. Tel.: +49 0 941 944 9801; fax: +49 0 941 944 9811. (Email: assadhaneya{at}web.de).

Background: Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard for surgical coronary re-vascularisation. Recently, minimised extracorporeal circulation system (MECC) has been postulated a safe and advantageous alternative for multi-vessel CABG. Method: Between January 2004 and December 2007, 244 high-risk patients (logistic EuroScore (ES) > 10%) underwent CABG in our institution. ECC was used in 139 (57%) and MECC in 105 (43%) patients. Demographic data including age (MECC: 73.4 ± 7.4 years; ECC: 73.3 ± 6.4 years), ES (MECC: 19.2 ± 9.8%; ECC: 21.4 ± 11.9%), left-ventricular ejection fraction (MECC: 45.6 ± 16.1%; ECC: 43.1 ± 15.3%), diabetes mellitus (MECC: 14.3%; ECC: 15.1%) and COPD (MECC: 6.7%; ECC: 7.9%) did not differ between the two groups. Preoperative end-stage renal failure was an exclusion criterion. The clinical course and serological/haematological parameters in the ECC and MECC patients were compared in a retrospective manner. Results: Although the numbers of distal anastomoses did not differ between the two groups (MECC: 3.0 ± 0.9; ECC: 2.9 ± 0.9), ECC time was significantly shorter in the MECC group (MECC: 96 ± 33 min; ECC: 120 ± 50 min, p < 0.01). Creatinine kinase (CK) levels were significantly lower 6 h after surgery in the MECC group (MECC: 681 ± 1505 U l^–1; ECC: 1086 ± 1338 U l^–1, p < 0.05) and the need of red blood cell transfusion was significantly less after MECC surgery (MECC: 3 [range: 1–6]; ECC: 5 [range: 2–9] p < 0.05). Moreover, 30-day mortality was significantly lower in the MECC group as compared to the ECC group (MECC: 12.4%; ECC: 26.6, p < 0.01). Discussion: MECC is a safe alternative for CABG surgery. A lower 30-day mortality, lower transfusion requirements and less renal and myocardial damage encourage the use of MECC systems, especially in high-risk patients.

Key Words: Extracorporeal circulation (ECC) • Minimised extracorporeal circulation system (MECC) • Coronary artery bypass grafting (CABG) • EuroScore • High-risk patients