Thorac Cardiovasc Surg 2013; 61 - SC72
DOI: 10.1055/s-0032-1332570

Emergency coronary artery bypass surgery using minimized extracorporeal circulation compared to conventional extracorporeal circulation

M Ried 1, P Kolat 1, A Haneya 1, L Rupprecht 1, R Kobuch 1, S Hirt 1, M Hilker 1, C Diez 1, C Schmid 1
  • 1Universitätsklinikum Regensburg, Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Regensburg, Germany

Objectives: Coronary artery bypass grafting (CABG) with conventional extracorporeal circulation (CECC) in emergency patients is associated with increased mortality. The proposed advantages of minimized extracorporeal circulation (MECC) on outcome after emergency CABG were evaluated.

Methods: Between January 2005 and December 2010 348 patients underwent emergency CABG with MECC (n = 153; 44%) or CECC (n = 195; 56%) and were retrospectively analysed. Patients with preoperative dialysis were excluded from analysis. Primary endpoint was 30-day mortality.

Results: Gender, age and most of preoperative patient characteristics and risk factors were nearly similar in both study groups. Patients treated with CECC had a significantly higher mean logistic EuroSCORE (16.2% vs. 12.5%; p = 0.008), a reduced ejection fraction (50% vs. 60%; p < 0.001) and an impaired renal function (eGFR < 60 mL/min/1.73 m2: 68% vs. 35%; p = 0.02) compared to MECC-patients. Left internal mammary artery was significantly used more often in MECC patients (80% vs. 66%, p = 0.004). Cardiopulmonary bypass and aortic-cross clamping time were significantly lower in the MECC group (p < 0.001; p = 0.003) as well as duration of postoperative ventilation. Postoperative low cardiac output syndrome was significantly more frequent in the CECC group (13.3% vs. 5.2%; p = 0.01). Need of postoperative renal replacement therapy, length of intensive care unit and hospital stay were comparable. Overall unadjusted 30-day mortality was significantly higher in patients treated with CECC (16.4% vs. 8.5%, p = 0.04). Adjusted mortality using the logistic EuroSCORE showed only slightly but significant difference (13.5% vs. 12.2%; p = 0.04). In this sample conventional extracorporeal circulation itself did not present as an independent risk factor for 30-day mortality.

Conclusion: Emergency patients are still at high risk for mortality after CABG. Postoperative mortality in emergency patients treated with MECC was significantly lower than in patients with CECC, even after adjusting for relevant risk factors. The MECC system may be an alternative for emergency CABG.