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DOI: 10.1055/s-0031-1297574
Outcomes in patients undergoing surgery with a minimized extracorporeal circulation compared to off pump revascularization
Aims: Conventional coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is associated with adverse effects such as systemic inflammatory response (SIRS) leading to a decrease in systemic vascular resistance (SVR) and hemodynamic instability. Owing to the technical improvements in the past decades modern “less invasive” methods of CABG have been established potentially avoiding the negative side effects of ECC. The aim of this study was to compare two CABG ECC approaches focusing on perioperative outcome particularly with regard to hemodynamic characteristics.
Methods: In this prospective randomized clinical trial 120 patients referred for CABG were assigned either to off pump coronary artery bypass (OPCAB) or to ECC procedure with utilization of a minimized circuit (Mini-HLM, ROCsafeTM). Patient demographics, preoperative characteristics and postoperative outcome were analyzed for both groups. Hemodynamic data (cardiac index, central venous saturation, central venous pressure, pulmonary capillary wedge pressure, pulmonary and systemic vascular resistance and arterial pressure) were measured at seven time points perioperatively.
Results: The mean age of the population was 65.6±10.8 and 18.3% of patients were female. There were no differences regarding preoperative morbidities between the two groups. The operating time was significantly longer in the Mini-HLM-group (178.3±32.9) compared to the OPCAB-group (133.2±32.7, p<0.001) with a significant higher number of grafts in the Mini-HLM-group (3.11±0.7 vs. 1.78±0.7, p<0.001). There were no significant differences in perioperative hemodynamic criteria inotropic support, hospital (p=0.534) and intensive care unit stay (p=0.88), ventilation time (p=0.113), blood loss (p=0.57), transfusion requirements, postoperative atrial fibrillation rate (p=0.706) and neurocognitive disturbance (p=0.297). There were no deaths and no myocardial infarctions observed in both groups.
Conclusion: Conceptional advantages of minimized ECC systems result in perioperative hemodynamics and clinical outcome comparable to OPCAB procedures. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity and mortality while allowing more complete revascularization. Therefore, particularly in patients with multivessel disease the use of the Mini-HLM may help improving outcome. However further clinical studies are necessary to validate these preliminary results.