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

Background: Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard for surgical coronary revascularisation. 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 tower 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 tower 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. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.