Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients.

Abstract

OBJECTIVE:

Coronary artery bypass grafting (CABG) is the gold standard for the surgical therapy of multivessel coronary artery disease. To reduce the side effects, associated with standard extracorporeal circulation (ECC), a concept of minimal extracorporeal circulation (MECC) was devised in our center. We report on our 10-year experience with the MECC for coronary revascularization.

METHODS:

From January 1998 to August 2009, 2243 patients underwent CABG with MECC in our center. In a retrospective observational study, we analyzed indication, preoperative patient co-morbidity, postoperative clinical course, and perioperative outcome of all patients operated on with MECC. Furthermore, the risk factors for mortality in the MECC group were assessed.

RESULTS:

Patients showed a mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 4.5±0.1%. The mean age of the patients was 66.8±9.1 years. The overall 30-day mortality after CABG with MECC was 2.3%, ranging from 1.1% for elective to 13.0% for emergent patients and was significantly better than standard ECC. Only 15.3% (n=344) of patients with MECC required intra-operative blood transfusion. Postoperative catecholamine support, red blood cell transfusion, need for hemodialysis, release of creatinine kinase, incidence of stroke, and postoperative delirium were low after MECC revascularization. Ejection fraction below 30% (odds ratio (OR): 5.1), emergent operation (OR: 9.4), and high-dose catecholamine therapy (OR: 2.6) were associated predictors for mortality.

CONCLUSION:

MECC until now is an established concept and has become an alternative for ECC in routine CABG in our center. The use of the MECC system is associated with low mortality and conversion rate. Excellent survival rates and low transfusion requirements in the perioperative course were achieved.

• Authors: Thomas Puehler, Assad Haneya, Alois Philipp, York A Zausig, Reinhard Kobuch, Claudius Diez, Dietrich E Birnbaum, Christof Schmid
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 39 Issue 4 Pg. 459-64 (Apr 2011) ISSN: 1873-734X [Electronic] Germany
• PMID: 20851618 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Chemical References

• Hemoglobins
• Lactates
• Creatinine

Topics

• Aged
• Coronary Artery Bypass (methods, mortality)
• Coronary Disease (mortality, surgery)
• Creatinine (metabolism)
• Extracorporeal Circulation (methods, mortality)
• Female
• Hematocrit
• Hemoglobins (metabolism)
• Hospital Mortality
• Humans
• Lactates (metabolism)
• Male
• Middle Aged
• Postoperative Complications (mortality)
• Retrospective Studies
• Risk Factors
• Treatment Outcome