1
|
Angelini GD, Reeves BC, Culliford LA, Maishman R, Rogers CA, Anastasiadis K, Antonitsis P, Argiriadou H, Carrel T, Keller D, Liebold A, Ashkaniani F, El-Essawi A, Breitenbach I, Lloyd C, Bennett M, Cale A, Gunaydin S, Gunertem E, Oueida F, Yassin IM, Serrick C, Murkin JM, Rao V, Moscarelli M, Condello I, Punjabi P, Rajakaruna C, Deliopoulos A, Bone D, Lansdown W, Moorjani N, Dennis S. Conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery: A randomized controlled trial (COMICS). Perfusion 2024:2676591241258054. [PMID: 38832503 DOI: 10.1177/02676591241258054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest. METHODS This is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation. The primary outcome was a composite of 12 post-operative SAEs up to 30 days after surgery, the risk of which MiECC was hypothesized to reduce. Secondary outcomes comprised: other SAEs; all-cause mortality; transfusion of blood products; time to discharge from intensive care and hospital; health-related quality-of-life. Analyses were performed on a modified intention-to-treat basis. RESULTS The trial terminated early due to the COVID-19 pandemic; 1071 participants (896 isolated CABG, 97 isolated AVR, 69 CABG + AVR) with median age 66 years and median EuroSCORE II 1.24 were randomized (535 to MiECC, 536 to CECC). Twenty-six participants withdrew after randomization, 22 before and four after intervention. Fifty of 517 (9.7%) randomized to MiECC and 69/522 (13.2%) randomized to CECC group experienced the primary outcome (risk ratio = 0.732, 95% confidence interval (95% CI) = 0.556 to 0.962, p = 0.025). The risk of any SAE not contributing to the primary outcome was similarly reduced (risk ratio = 0.791, 95% CI 0.530 to 1.179, p = 0.250). CONCLUSIONS MiECC reduces the relative risk of primary outcome events by about 25%. The risk of other SAEs was similarly reduced. Because the trial terminated early without achieving the target sample size, these potential benefits of MiECC are uncertain.
Collapse
Affiliation(s)
| | | | | | | | - Chris A Rogers
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Helena Argiriadou
- Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | | | | | | | | | | | | | - Clinton Lloyd
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Mark Bennett
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Alex Cale
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Serdar Gunaydin
- Numune Training and Research Hospital in Ankara, Ankara, Turkey
| | - Eren Gunertem
- Numune Training and Research Hospital in Ankara, Ankara, Turkey
| | - Farouk Oueida
- Saud Al-Babtain Cardiac Centre, Dammam, Saudi Arabia
| | | | | | | | - Vivek Rao
- University Health Network, Toronto, ON, Canada
| | | | | | | | - Cha Rajakaruna
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Daniel Bone
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | |
Collapse
|
2
|
Carrel T. Reduced Invasiveness of Cardiopulmonary Bypass: The Mini-Circuit and the Micro-Cardioplegia. J Cardiovasc Dev Dis 2023; 10:290. [PMID: 37504545 PMCID: PMC10380229 DOI: 10.3390/jcdd10070290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
The aim of cardiopulmonary bypass is the maintenance of a sufficient whole body perfusion and gas exchange during open or closed heart surgery procedure (coronary artery bypass grafting, valve repair and replacement, surgical intervention on the ascending aorta and/or aortic arch, repair of congenital malformations, and finally implantation of ventricular assist devices or cardiac transplantation). The main components of cardiopulmonary bypass are the pump that supplies the circulation and the oxygenator that regulates gas exchange. However, even though this technology has been extensively developed and improved over the last decades, one of the major drawbacks-which is the fact that blood has to flow through tubing systems with foreign surfaces-persists so far. Nevertheless, interesting innovations have been made more recently in order to better control the side-effects that culminate into a major activation of the coagulation and inflammatory systems: among them, miniaturization of the circuits, together with reduction of the priming volume and a simplified cardioplegia concept. All of these lead to a significant decrease of hemodilution and thereby a significant reduction of volume overload during surgery. In this brief review we will present some of these most interesting topics around minimized circuits and the simplified low-volume cardioplegia and discuss their potential benefits on the clinical outcome.
Collapse
Affiliation(s)
- Thierry Carrel
- Departement of Cardiac Surgery, University of Zürich, CH-8006 Zürich, Switzerland
- Department of Cardiac Surgery, University Hospital Basel, CH-4052 Basel, Switzerland
| |
Collapse
|
3
|
Conventional versus minimally invasive extracorporeal circulation in patients undergoing cardiac surgery: protocol for a randomised controlled trial (COMICS). Perfusion 2020; 36:388-394. [PMID: 32781894 PMCID: PMC8167910 DOI: 10.1177/0267659120946731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Despite low mortality, cardiac surgery patients may experience serious life-threatening post-operative complications, often due to extracorporeal circulation and reperfusion. Miniaturised cardiopulmonary bypass (minimally invasive extracorporeal circulation) has been developed aiming to reduce the risk of post-operative complications arising with conventional extracorporeal circulation. Methods: The COMICS trial is a multi-centre, international, two-group parallel randomised controlled trial testing whether type II, III or IV minimally invasive extracorporeal circulation is effective and cost-effective compared to conventional extracorporeal circulation in patients undergoing elective or urgent coronary artery bypass grafting, aortic valve replacement or coronary artery bypass grafting + aortic valve replacement. Randomisation (1:1 ratio) is concealed and stratified by centre and surgical procedure. The primary outcome is a composite of 12 serious complications, objectively defined or adjudicated, 30 days after surgery. Secondary outcomes (at 30 days) include other serious adverse events (primary safety outcome), use of blood products, length of intensive care and hospital stay and generic health status (also at 90 days). Status of the trial: Two centres started recruiting on 08 May 2018; 10 are currently recruiting and 603 patients have been randomised (11 May 2020). The recruitment rate from 01 April 2019 to 31 March 2020 was 40-50 patients/month. About 80% have had coronary artery bypass grafting only. Adherence to allocation is good. Conclusions: The trial is feasible but criteria for progressing to a full trial were not met on time. The Trial Steering and Data Monitoring Committees have recommended that the trial should currently continue.
Collapse
|
4
|
Tamargo CL, Botros M, Saveanu RV. The relationship between neurocognitive decline and the heart-lung machine. J Card Surg 2020; 35:1057-1061. [PMID: 32176380 DOI: 10.1111/jocs.14505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Surgery involving the use of cardiopulmonary bypass (CPB) has long been associated with cerebral changes and may also contribute to adverse neurocognitive outcomes. However, there is a debate as to whether bypass itself is responsible for these changes. We conducted a systematic literature review on PubMed, supplementing our work with recent articles from other sources to examine the current evidence on neurocognitive decline associated with CPB. While surgeries involving CPB appear to be associated with cerebral changes and potentially with neurocognitive decline, it is unclear as to whether decline is related to the procedure itself. It is possible that the impacts of CPB can be more readily observed among individuals with preoperative cognitive impairment. It is thus important to screen for subtle and more apparent preoperative cognitive impairment as a risk factor for adverse outcomes. Further research, comparing on-pump and off-pump cohorts and involving intensive screening of preoperative cognitive decline, is indicated to elucidate the true neurocognitive consequences of the heart-lung machine.
Collapse
Affiliation(s)
- Christina L Tamargo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mousa Botros
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Radu V Saveanu
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
5
|
Emced K. Atrial fibrillation and gamma glutamyl transferase; Off-pump versus on-pump Coronary Artery Bypass surgery. SANAMED 2020. [DOI: 10.24125/sanamed.v15i2.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Atrial fibrillation (AF) which can be seen as a complication of the open-heart surgery, may cause serious problems on postoperative period. The exact pathophysiology of AF is unknown but it is thought that factors such as oxidative stress might cause AF. Material and methods: We retrospectively surveyed the serum gamma-glutamyl transferase (GGT) levels which is accepted as a mediator of oxidative stres, for the Post Operative Atrial Fibrillation (POAF) that occur after of-pump versus on-pump Coronary Artery Bypass Graft (CABG) surgery. Our study included 183 cases (101 male, 72 female; median age 63 ± 4.3 years) of which CABG was performed. Results: Echocardiography, routine blood tests, electrocardiography (ECG), test for the serum GGT levels were performed in preoperative and postoperative period to all participants. AF developed in 34 patients (35 %) in Group I and 19 patients (20 %) in Group II. There were no significant differences between two groups (of-pump versus on-pump) in terms of gender, cardiovascular risk factors and the severity of the coronary artery disease. In patients who has developed AF in postoperative period had significantly higher serum GGT levels. Conclusion: This study has shown that serum GGT levels were found to be significantly higher in patients whom AF has developed after on-pump CABG surgery.
Collapse
|
6
|
Ippoliti F, Piscioneri F, Sartini P, Peruzzi M, Domenico MD, Dannhauser D, Rossi D, Causa F, Netti PA, Miraldi F, Greco E, Marullo A, Iaccarino A, Cavarretta E, Zoccai GB, Sciarretta S, Frati G. Comparative spallation performance of silicone versus Tygon extracorporeal circulation tubing. Interact Cardiovasc Thorac Surg 2019; 29:685-692. [PMID: 31302701 DOI: 10.1093/icvts/ivz170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
OBJECTIVES
Reports ranged from mixed to marginal tubing wear and spallation effects as a complication of roller pumps in cardiopulmonary bypass (CPB). Because the rollers constantly compress part of the tubing, we sought to determine whether circuit materials behave differently under a 3-h simulation of CPB.
METHODS
Two different tubing materials (silicone and Tygon) were tested with a customized experimental circuit, designed to allow in vitro simulation of CPB with priming volumes, pressures, revolutions per minute and temperatures equivalent to the clinical scenario. Samples were analysed with optical and field-emission scanning electron microscopy. We collected 200-ml fluid samples at 4 different times: before starting the CPB (T0), when the predicted revolutions per minute corresponded to about 2 min of CPB (T1), at 90 min (T2) and at 180 min (T3). At the end of CPB, we harvested 2 samples of tubing. Lastly, optical investigations and field-emission scanning electron microscopy observations were used for qualitative and quantitative analysis of circulating fragments.
RESULTS
T2 and T3 fluid samples showed more particles than T1 samples. Significant differences in terms of particle numbers were detected: silicone tubing released more fragments per millilitre than Tygon tubing, with both materials releasing particles from 5 to 500 µm. Silicone tubing was associated with a time-dependent increase in small particles released (P = 0.04), whereas this did not apply to large particles or to Tygon tubing. Yet, bootstrap estimates suggested that silicone tubing was associated with the release of more small particles whereas Tygon tubing released more large particles (both P < 0.01). Unlike silicone, Tygon samples taken from the portion of the circuit not subjected to the action of the roller pump did not show any erosion on their surfaces. Samples of both materials taken from the portion subjected to the compression of the roller pump showed signs of significant deterioration.
CONCLUSIONS
Silicone showed a worse spallation performance than Tygon, thus appearing less safe for more complex surgery of prolonged duration or for patients with a prior cerebral ischaemic event. Additional risk and cost-effectiveness comparisons to determine the potential benefits of one type of tubing material over the other are warranted to further expand our findings.
Collapse
Affiliation(s)
- Francesco Ippoliti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, “Umberto I” Hospital, “La Sapienza” University of Rome, Rome, Italy
| | - Fernando Piscioneri
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, “Umberto I” Hospital, “La Sapienza” University of Rome, Rome, Italy
| | - Patrizio Sartini
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, “Umberto I” Hospital, “La Sapienza” University of Rome, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Marina Di Domenico
- Department of Biochemistry, Biophysics and General Pathology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - David Dannhauser
- Center for Advanced Biomaterials for Health Care@CRIB, Istituto Italiano di Tecnologia, Naples, Italy
| | - Domenico Rossi
- Center for Advanced Biomaterials for Health Care@CRIB, Istituto Italiano di Tecnologia, Naples, Italy
| | - Filippo Causa
- Interdisciplinary Research Centre on Biomaterials (CRIB) and Dipartimento di Ingegneria Chimica, dei Materiali e della Produzione Industriale (DICMAPI), Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Paolo Antonio Netti
- Center for Advanced Biomaterials for Health Care@CRIB, Istituto Italiano di Tecnologia, Naples, Italy
- Interdisciplinary Research Centre on Biomaterials (CRIB) and Dipartimento di Ingegneria Chimica, dei Materiali e della Produzione Industriale (DICMAPI), Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, “Umberto I” Hospital, “La Sapienza” University of Rome, Rome, Italy
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, “Umberto I” Hospital, “La Sapienza” University of Rome, Rome, Italy
| | - Antonino Marullo
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
| | - Alessandra Iaccarino
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- Department of Cardiac Surgery, Humanitas University, Milan, Italy
| | - Elena Cavarretta
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Sebastiano Sciarretta
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Giacomo Frati
- Department of Medical Surgical Sciences and Biotechnology, “La Sapienza” University of Rome, Rome, Italy
- IRCCS NEUROMED, Pozzilli, IS, Italy
| |
Collapse
|
7
|
Anastasiadis K, Argiriadou H, Deliopoulos A, Antonitsis P. Minimal invasive extracorporeal circulation (MiECC): the state-of-the-art in perfusion. J Thorac Dis 2019; 11:S1507-S1514. [PMID: 31293801 DOI: 10.21037/jtd.2019.01.66] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Helena Argiriadou
- Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece
| | | | | |
Collapse
|
8
|
Perioperative Outcomes, Transfusion Requirements, and Inflammatory Response After Coronary Artery Bypass Grafting With Off-Pump, Mini-Extracorporeal, and On-Pump Circulation Techniques. J Investig Med 2016; 63:916-20. [PMID: 26448506 DOI: 10.1097/jim.0000000000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Mini-extracorporeal circulation (MECC) units were developed to reduce postoperative morbidity, transfusion requirements, and inflammation associated with conventional on-pump coronary artery bypass (ONCAB) surgery without the technical demands of the off-pump (OPCAB) technique. We compared perioperative outcomes and inflammatory mediation among OPCAB, MECC, and ONCAB techniques. METHODS We prospectively enrolled 102 patients undergoing elective isolated coronary bypass grafting. Perfusion methods were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood samples were collected to measure serum inflammatory markers. RESULTS There were no operative deaths or strokes. Total red blood cell (RBC) products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and 1.235 units, respectively. Adjusted (by splined Society of Thoracic Surgeons operative risk score) analysis showed no statistically significant differences in mean RBC product use among the different operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311; MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk score and baseline level) mean plasma level differences (24 hours postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95% confidence interval [95% CI], 106.23-129.54) and for MECC (124.88; 95% CI, 113.45-136.32) were significantly higher than for ONCAB (98.82; 95% CI, 86.40-111.24). No significant adjusted differences (P = 0.304) in interleukin-6 level changes were observed. CONCLUSIONS Off-pump coronary artery bypass and MECC did not significantly reduce mean total RBC transfusion requirements. Off-pump coronary artery bypass and MECC were associated with greater C-reactive protein elevation than ONCAB, suggestive of an increased inflammatory response to each of these techniques.
Collapse
|
9
|
Mizuno T, Egi K, Sakai K, Oi K, Hachimaru T, Makita T, Oishi K, Arai H. Minimally Circulatory-Assisted On-Pump Beating Coronary Artery Bypass Grafting for Patients With Complex Conditions for Off-Pump Surgery. Artif Organs 2016; 41:233-241. [PMID: 27782315 DOI: 10.1111/aor.12761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/16/2016] [Accepted: 03/23/2016] [Indexed: 01/16/2023]
Abstract
Off-pump coronary artery bypass grafting (OPCAB) in patients with acute myocardial infarction (AMI) is difficult because of circulatory deterioration during displacement of the heart. At our institution, we performed minimally circulatory-assisted on-pump beating coronary artery bypass grafting (MICAB) in these patients. During MICAB, support flow was controlled at a minimal level to maintain a systemic blood pressure of approximately 100 mm Hg and a pulmonary arterial systolic pressure of <30 mm Hg, providing optimal pulsatile circulation for end-organ perfusion and prevention of heart congestion. From September 2006 to March 2012, MICAB was performed in 37 patients. Either emergent or urgent MICAB was performed in 27 patients following AMI because of hemodynamic instability during reconstruction. Elective MICAB was performed in the remaining 10 patients because of dilated left ventricle (LV) or small target coronary arteries. The details of bypass grafts, perioperative renal function, and early and mid-term morbidity and mortality were compared between the patients who received MICAB and the 37 consecutive patients who underwent OPCAB during the study period at our hospital. The assist flow indices (actual support flow/body surface area) during anastomosis to the left anterior descending artery, left circumflex artery, and right coronary artery were 0.95 ± 0.48 L/min/m2 , 1.32 ± 0.53 L/min/m2 , and 1.15 ± 0.47 L/min/m2 , respectively, in the emergent and urgent patients following AMI, and 0.44 ± 0.39 L/min/m2 , 1.25 ± 0.39 L/min/m2 , and 1.14 ± 0.43 L/min/m2 , respectively, in the elective patients with either dilated LVs or small target vessels. The lowest mixed venous oxygen saturation during pump support in the MICAB group was significantly higher than that in the OPCAB group (83.8 ± 10.8%, 71.6 ± 7.5%, P < 0.001). Comparing MICAB and OPCAB, the median number of distal bypass grafts for both groups was 4 (25th, 75th percentile: 3, 4) (P = 0.558); the complete revascularization rates were 94.6 and 97.3%, respectively (not significant [NS]); the acute patency rates were 98.9 and 99.2%, respectively (NS); and the 30-day mortality rates were 2.7 and 0%, respectively (NS). No instances of either cerebrovascular complications or newly occurring postoperative renal failure were noted in either group. There were no statistically significant differences between the groups with respect to early and mid-term results (freedom from all-cause death: 82.9 vs. 86.5%, respectively, and freedom from cardiac events at 3 years: 96.4 vs. 96.4%, respectively). MICAB is a safe alternative to OPCAB, particularly in patients with AMI and dilated LV. MICAB is associated with high rates of complete revascularization and acute graft patency, adequate preservation of end-organ function, and early and mid-term results comparable with those observed following OPCAB.
Collapse
Affiliation(s)
- Tomohiro Mizuno
- Department of Cardiovascular Surgery, Machida Municipal Hospital, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Koso Egi
- Department of Cardiovascular Surgery, Tokyo Yamate Medical Center
| | - Kenji Sakai
- Department of Cardiovascular Surgery, Machida Municipal Hospital
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Tsuyoshi Hachimaru
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Tohru Makita
- Department of Cardiovascular Surgery, Yokosuka Kyosai Hospital
| | - Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| |
Collapse
|
10
|
Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian Method. Ann Thorac Surg 2016; 103:342-350. [PMID: 27780561 DOI: 10.1016/j.athoracsur.2016.08.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/12/2016] [Accepted: 08/19/2016] [Indexed: 11/22/2022]
Abstract
The pathophysiologic side effects of cardiopulmonary bypass have already been identified. Minimally invasive extracorporeal circulation technologies (MiECT) and off-pump coronary artery bypass graft surgery (OPCABG) aim to reduce these problems. This meta-analysis provides a comparison of MiECT and OPCABG in randomized and observational studies. A fully probabilistic, Bayesian approach of primary and secondary endpoints was conducted. MiECT does not give inferior results when compared with OPCABG. However, there is a trend to borderline significantly higher blood loss in this group in randomized controlled trials. The question whether MiECT is equivalent to OPCABG can be answered with the affirmative, but long-term follow-up data are needed to detect any advantage over time.
Collapse
|
11
|
Abstract
INTRODUCTION Cardiopulmonary bypass has undoubtedly been the cornerstone in the rapid development of cardiac surgery, allowing even the performance of procedures beyond the scope of cardiothoracic surgery. Its use however, is associated with significant complications that arise from the mechanical effects of the circuit on circulating blood components as well as the contact of blood with non-endothelial surfaces. Miniature cardiopulmonary bypass systems have been developed in an attempt to minimize these complications. Areas covered: Herein clinical outcomes from the most recent studies in adult cardiac surgery are discussed. The main benefits of miniaturisation as well as potential areas of further application are described. Expert commentary: Data is critically appraised in the context of current guidelines. Finally the need for further basic science in addition to large multi-centre randomized controlled trial data is highlighted.
Collapse
Affiliation(s)
- Ioannis Dimarakis
- a Department of Cardiothoracic Surgery , Wythenshawe Hospital , Manchester , UK
| |
Collapse
|
12
|
Anastasiadis K, Antonitsis P, Bauer A, Carrel T. Minimal invasive extracorporeal circulation should become the standard practice in coronary revascularization surgery. Eur J Cardiothorac Surg 2016; 50:189. [PMID: 26834234 DOI: 10.1093/ejcts/ezw004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/07/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Adrian Bauer
- Department of Cardiovascular Surgery, MediClin Heartcenter, Coswig, Germany
| | - Thierry Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | | |
Collapse
|
13
|
Formica F, Bamodu OA, Mariani S, Caruso R, Sangalli F, Paolini G. Implantation of the Jarvik 2000® left ventricular assist device using the miniaturized extracorporeal circulation system - a case report. Perfusion 2016; 31:518-20. [PMID: 26791274 DOI: 10.1177/0267659115627692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myocardial failure is generally considered to be a progressive, irreversible medical condition with characteristic ventricular enlargement, spatial alteration of the heart chambers, diminished cardiac inotropy and resultant dysfunctional, mechanically inefficient heart.The Jarvik 2000®, similar to the mechanical pump, is an electrically powered, axial-flow left ventricular assist device (LVAD) designed to enhance the function of the chronically failing heart and, consequently, normalize the cardiac output for a long period of time.We report the case of 70-year-old man with congestive dilated cardiomyopathy and bioprosthetic mitral valve who underwent surgical implantation of the Jarvik 2000® LVAD, using the miniaturized extracorporeal circulation (MECC) system.The LVAD was implanted through a left thoracotomy and the MECC system was used to avoid intraoperative spontaneous hemodynamic instability and/or malignant ventricular arrhythmia. The circulatory support with the MECC system was optimal and no complication in terms of hemodynamic instability and perioperative bleeding was recorded. The MECC system obliterated the adverse effects associated with conventional extracorporeal circulation, which are often fatal in critically-ill patients.
Collapse
Affiliation(s)
- Francesco Formica
- Cardiac Surgery Unit, San Gerardo Hospital, Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy Cardiac Perfusion Unit, San Gerardo Hospital, Monza, Italy
| | - Oluwaseun Adebayo Bamodu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Medical Research & Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan The Masters Level II Program in Cardiac Surgery, Cardiac Anesthesia and Cardiology, University of Milano-Bicocca, Monza, Italy
| | - Serena Mariani
- Cardiac Surgery Unit, San Gerardo Hospital, Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy
| | - Rosa Caruso
- Cardiac Perfusion Unit, San Gerardo Hospital, Monza, Italy
| | - Fabio Sangalli
- Cardiac Anesthesia Unit, San Gerardo Hospital, Monza, Italy
| | - Giovanni Paolini
- Cardiac Surgery Unit, San Gerardo Hospital, Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy Cardiac Perfusion Unit, San Gerardo Hospital, Monza, Italy
| |
Collapse
|