Clinical advantages of using mini-bypass systems in terms of blood product use, postoperative bleeding and air entrainment: an in vivo clinical perspective.
OBJECTIVE
In an effort to minimize the effect of extracorporeal circulation (ECC), mini-bypass is gaining clinical acceptance in routine coronary artery bypass grafting (CABG). These small circuits target combine the clinical advantages of reduced prime, 100% bio-coating and suction blood separation. We demonstrate that the use of mini-bypass in routine CABG reduces homologous blood product use and postoperative bleeding. Our goal was to also demonstrate that these small systems are effective in gaseous microemboli (GME) management as compared to a conventional extracorporeal system.


METHODS
Prospective, randomized study comparing 30 mini-bypass (Dideco ECC.O) to 30 conventional systems (n=30, Dideco 903 Avant). Study included CABG cases only, independent of preoperative coagulative status; clinic ethical committee approval and informed patient consent was obtained before initiating study.


RESULTS
There were no statistical differences in terms of patient demographics. Statistically significant differences were seen in transfusion frequency (27% of the study group vs 43% in the control group, p=0.05), transfused volume (133.3+/-244.5 ml vs 325+/-483.1 ml, p<0.05), fresh frozen plasma (0 unit vs 3 units, p<0.001), postoperative bleeding (301.8+/-531.9 ml vs 785.5+/-1000.4 ml, p<0.05) and GME activity post-arterial filter (0.14 microl vs 5.32 microl, p<0.05).


CONCLUSIONS
The adoption of mini-bypass significantly potentially reduces hemodilution, donor blood usage, postoperative bleeding and exposure to GME in routine CABG patients as compared to the use of conventional extracorporeal circulation circuits.
Perthel
Mathias
M
Clinic for Cardiac and Thoracic Surgery, Cardiovascular Center Bad Bevensen, Roemstedter Strasse 25, 29549 Bad Bevensen, Germany. m.perthel@hgz-bb.de
El-Ayoubi
Lémir
L
Bendisch
Andreas
A
Laas
Joachim
J
Gerigk
Markus
M
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000379:methods; D003422:Critical Care / Q000379:methods; D004617:Embolism / Q000517:prevention & control*; D004618:Embolism, Air / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011446:Prospective Studies; D013923:Thromboembolism / Q000517:prevention & control