Minimally invasive cardiopulmonary bypass: does it really change the outcome?
BACKGROUND
Many innovative cardiopulmonary bypass (CPB) systems have recently been proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump, and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study aimed to verify the clinical impact of an MICPB in a large population of patients undergoing coronary artery revascularization.


METHODS
We conducted a retrospective analysis of 1,663 patients treated with an MICPB. The control group (conventional CPB) was extracted from a series of 2,877 patients according to a propensity score analysis.


RESULTS
Patients receiving an MICPB had a shorter intensive care unit (ICU) stay, had lower peak postoperative serum creatinine and bilirubin levels, and suffered less postoperative blood loss. Within a multivariable model, MICPB is independently associated with lower rates of atrial fibrillation (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69 to 0.99) and ventricular arrhythmias (OR 0.45, 95% CI 0.28 to 0.73) and with higher rates of early discharge from the ICU (OR 1.31, 95% CI 1.06 to 1.6) and from the hospital (OR 1.46, 95% CI 1.18 to 1.8). Hospital mortality did not differ between groups.


CONCLUSIONS
MICPBs are associated with reduced morbidity. However, these results will need to be confirmed in a large, prospective, randomized, controlled trial.
Ranucci
Marco
M
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico S, Donato, Via Morandi 30, San Donato Milanese (Milan) - 20097, Italy. cardioanestesia@virgilio.it
Isgrò
Giuseppe
G
D001663:Bilirubin / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000706:statistics & numerical data*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology
D003404:Creatinine; D001663:Bilirubin