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Blanco MJ, Vives M. "Con: Is Minimal Invasive Extracorporeal Circulation Superior to Conventional Cardiopulmonary Bypass in Cardiac Surgery?". J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00285-4. [PMID: 38908931 DOI: 10.1053/j.jvca.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/06/2024] [Accepted: 04/21/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Morillo J Blanco
- Perfusion Unit, Cardiovascular Surgery Department, University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - M Vives
- Department of Anesthesiology and Critical Care Medicine, Clinica Universidad de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
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Ozgur MM, Aksut M, Ozer T, Gurel B, Yerli İ, Şimşek M, Sarikaya S, Kırali K. Comparison of minimal invasive extracorporeal circulation versus standard cardiopulmonary bypass systems on coronary artery bypass surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:141-150. [PMID: 38933313 PMCID: PMC11197417 DOI: 10.5606/tgkdc.dergisi.2024.25584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/19/2024] [Indexed: 06/28/2024]
Abstract
Background In this study, we shared our experience with the minimal invasive extracorporeal circulation system for coronary artery bypass grafting patients. Methods A total of 163 patients were included in the retrospective study, with 83 patients (63 males, 20 females; mean age: 61.9±8.9 years; range, 35 to 81 years) undergoing coronary artery bypass grafting with minimal invasive extracorporeal circulation and 80 patients (65 males, 15 females; mean age: 60.5±8.8 years; range, 43 to 82 years) undergoing coronary artery bypass grafting with conventional cardiopulmonary bypass between July 2021 and April 2023. Elective coronary bypass performed by same surgical team were included in the study. Mortality, major adverse cardiac and cerebrovascular event, hospital stays and transfusion requirements were evaluated. Results There were no significant differences in sex distribution, age, comorbidities, and blood values between the two groups. Intraoperatively, the minimal invasive extracorporeal circulation group had a slightly higher number of distal anastomoses and comparable times for aortic cross-clamp and cardiopulmonary bypass. Postoperative outcomes such as tamponade, bleeding, atrial fibrillation, left ventricular ejection fraction improvement or reduction, and postoperative drainage were similar between the two groups. However, the minimal invasive extracorporeal circulation group had fewer transfusions of packed red blood cells and fresh frozen plasma and a shorter length of stay in the intensive care unit. Conclusion The minimal invasive extracorporeal circulation system effectively preserves blood, works with lower activated clotting time values without additional complications in coronary artery bypass grafting, and could present a better option for patients with anemia or patients with a relatively high risk for high-dose heparinization.
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Affiliation(s)
- Mustafa Mert Ozgur
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Aksut
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Tanıl Ozer
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Barış Gurel
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - İsmail Yerli
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Mine Şimşek
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Sabit Sarikaya
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
| | - Kaan Kırali
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Training and Research Hospital, İstanbul, Türkiye
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Chan J, Oo S, Butt S, Benedetto U, Caputo M, Angelini GD, Vohra HA. Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery. Perfusion 2023; 38:464-472. [PMID: 35225070 DOI: 10.1177/02676591221075522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Minimally invasive cardiac surgery has been evolving, with the intention of reducing surgical trauma, improve cosmesis and patient satisfaction. Single dose, crystalloid cardioplegia such as Del Nido cardioplegia and Custoidol solution have been increasingly used to reduce the interruption from repeating cardioplegia dosing to minimise the cardiopulmonary bypass and cross clamp time. However, the best cardioplegia for myocardial protection in adult minimally invasive cardiac surgery remains controversial. We aimed to conduct a meta-analysis to analyse the current evidence in the literature. METHOD A systematic review and meta-analysis was performed following the updated 2020 PRISMA guideline. Articles published in the five major electronic databases up 1st of April 2021 were identified and reviewed. The primary outcome was in-hospital or 30-day mortality. Traditional pairwise and Bayesian network meta-analyses were conducted. RESULTS Nine articles were included in this study. The use of Del Nido cardioplegia was associated with a lower volume of cardioplegia used (Del Nido vs Blood, 1105.62 mL+/-123.47 vs 2569.46 mL+/-1515.52, p<0.001), cardiopulmonary bypass (Del Nido vs Custoidol vs Blood: 91.67+/-14.78 vs 138.05 +/- 21.30 vs 119.38+/-26.91 minutes, p<0.001) and cross-clamp time (Del Nido vs Custoidol vs Blood: 74.99+/-18.55 vs 82.01 +/- 17.28 vs 93.66+/-8.88 minutes, p < 0.001). No differences were observed in the incidence of in-hospital/30-day mortality rate, new onset of atrial fibrillation and stroke. Ranking analysis showed the Custoidol solution has the highest probability to be the first ranked cardioplegia. CONCLUSION No differences were found between blood and crystalloid cardioplegia in adult minimally invasive cardiac surgery in several clinical outcomes. The cardioplegia of choice in minimally invasive cardiac surgery remains the surgeons' decision and preference.
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Affiliation(s)
- Jeremy Chan
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Shwe Oo
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Salman Butt
- Department of Perfusion Sciences, 156611St George's Hospital, London UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, 156596Bristol Royal Hospital for Children, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
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Yang K, Huang H, Dai R, Zhang J, Wei X, Gao F, Wu X, Wu F, He S, Xin M. Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery. J Cardiothorac Surg 2023; 18:56. [PMID: 36732795 PMCID: PMC9896670 DOI: 10.1186/s13019-023-02175-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The adverse effects of cardiopulmonary bypass during open cardiac surgery, including hemodilution, seem to be inevitable, especially for patients who generally have a relatively lower BMI with relatively small blood volumes. This study reports the modification and use of a cardiopulmonary bypass (CPB) system to reduce priming volume and hemodilution. METHODS This is a retrospective study of 462 adult patients who underwent cardiac valve replacement surgery from January 2019 to September 2021 at the General Hospital of Western Theater Command. The modified group consisted of 212 patients undergoing modified CPB. The control group included 250 patients receiving conventional CPB. Evaluated indices included fluid intake and output volumes during CPB, intraoperative indices related to CPB operation, usage of blood products during the peri-CPB period, and postoperative outcomes. RESULTS The modified group displayed a significant reduction in the crystalloid (200 mL vs. 600 mL, P < 0.05) and colloid priming volumes (450 mL vs. 1100 mL, P < 0.05), and ultrafiltration solution volume (750 mL vs. 1200 mL, P < 0.05). Furthermore, the modified group had a significantly lower rate of defibrillation (30.2% vs. 41.2%, P < 0.05). The intraoperative urine volume (650 mL vs. 500 mL, P < 0.05) and intraoperative hematocrit (Hct) (26% vs. 24%, P < 0.05) of the modified CPB group were also higher than in the control group. The modified group required a lower infusion volume of packed red blood cells (250 mL vs. 400 mL, P < 0.05) and lower infusion rates of packed red blood cells (17.9% vs. 25.2%, P < 0.05) and fresh frozen plasma (1.41% vs. 5.2%, P < 0.05). In addition, the modified group showed significantly improved indices related to postoperative recovery. CONCLUSIONS The modified CPB system effectively conserves blood and shows noteworthy potential for application in cardiac valve replacement surgery.
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Affiliation(s)
- Ke Yang
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China ,grid.263901.f0000 0004 1791 7667Present Address: College of Medicine, Southwest Jiaotong University, Chengdu, 610036 China
| | - Honghao Huang
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China ,grid.263901.f0000 0004 1791 7667Present Address: College of Medicine, Southwest Jiaotong University, Chengdu, 610036 China
| | - Ruiwu Dai
- grid.263901.f0000 0004 1791 7667Present Address: College of Medicine, Southwest Jiaotong University, Chengdu, 610036 China ,grid.413855.e0000 0004 1764 5163General Surgery Center, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, 610036 China
| | - Jinbao Zhang
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Xiaohong Wei
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Feng Gao
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Xiaochen Wu
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Fan Wu
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Siyi He
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
| | - Mei Xin
- grid.413855.e0000 0004 1764 5163Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, Chengdu, 610036 China
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Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. Perfusion matters, and it will always matter in cardiac surgery. Perfusion 2021; 36:677-678. [PMID: 34148398 DOI: 10.1177/02676591211025154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Anastasiadis K, Antonitsis P, Asteriou C, Deliopoulos A, Argiriadou H. Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature. Perfusion 2021; 37:852-862. [PMID: 34137323 DOI: 10.1177/02676591211026514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Despite extensive evidence that shows clinical of superiority of MiECC, worldwide penetration remains low due to concerns regarding air handling and volume management in the context of a closed system. The purpose of this study is to thoroughly investigate perfusion safety and technical feasibility of performing all cardiac surgical procedures with modular (hybrid) MiECC, as experienced from the perfusionist's perspective. METHODS We retrospectively reviewed perfusion charts of consecutive adult patients undergoing all types of elective, urgent, and emergency cardiac surgery under modular MiECC. The primary outcome measure was perfusion safety and technical feasibility, as evidenced in the need for conversion from a closed to an open circuit. A systematic review of the literature was conducted aiming to ultimately clarify whether there are any safety issues regarding MiECC technology. RESULTS We challenged modular MiECC use in a series of 403 consecutive patients of whom a significant proportion (111/403; 28%) underwent complex surgery including reoperations (4%), emergency repair of acute type A aortic dissection and composite aortic surgery (1.7%). Technical success rate was 100%. Conversion to an open circuit was required in 18/396 patients (4.5%), excluding procedures performed under circulatory arrest. Open configuration accounted for 40% ± 21% of total procedural perfusion time and was related to significant hemodilution and increase in peak lactate levels. Systematic review revealed that safety of the procedure challenged originated from a single report, while no clinical adverse event related to MiECC was identified. CONCLUSIONS Use of modular MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. It represents a type III active closed system, while its stand-by component is reserved for a small (<5%) proportion of procedures and for a partial procedural time. Thus, it eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.
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Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Asteriou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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