title: Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization.
abstract: BACKGROUND
  Coronary artery bypass surgery employing minimal extracorporeal circulation (MECC) was compared with standard extracorporeal circulation (ECC) and off-pump coronary artery bypass graft surgery (OPCABG) with regard to the perioperative course.
  
  
  METHODS
  From January 2004 to December 2007, 1,674 patients (n = 558 MECC, n = 558 ECC, n = 558 OPCABG) who underwent coronary bypass surgery were studied. The primary end point was in-hospital mortality; secondary end points were perioperative variables, intensive care, and in-hospital course.
  
  
  RESULTS
  Demographic data, comorbidity, and the European System for Cardiac Operative Risk Evaluation score (MECC 3.0%, ECC 3.5%, OPCABG 3.2%) were similar among the groups, but in-hospital mortality for elective and urgent/emergent patients was lower in the MECC and OPCABG groups (MECC 3.2%, OPCABG 3.7%, ECC 6.9%; p < 0.05). The number of distal anastomoses was lowest in the OPCABG group, but comparable for MECC and ECC patients. Postoperative ventilation time, release of creatinine kinase, catecholamine therapy, drainage loss, and transfusion requirements were lower in the MECC and OPCABG groups, whereas stay in the intensive care unit was shorter only in the latter (p < 0.05).
  
  
  CONCLUSIONS
  Minimal extracorporeal circulation is an easy and safe procedure for coronary artery bypass graft surgery. In selected patients, the advantages of MECC equal those of OPCABG. MECC should be considered as an alternative to OPCABG and standard ECC procedures.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany. thomas.puehler@klinik.uni-regensburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Puehler
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Karsten
authors.initials: K
authors.lastname: Wiebe
authors.forename: Andreas
authors.initials: A
authors.lastname: Keyser
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Stephan
authors.initials: S
authors.lastname: Hirt
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome