Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization.
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.
Puehler
Thomas
T
Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany. thomas.puehler@klinik.uni-regensburg.de
Haneya
Assad
A
Philipp
Alois
A
Wiebe
Karsten
K
Keyser
Andreas
A
Rupprecht
Leopold
L
Hirt
Stephan
S
Kobuch
Reinhard
R
Diez
Claudius
C
Hilker
Michael
M
Schmid
Christof
C
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