Miniaturized cardiopulmonary bypass improves short-term outcome in cardiac surgery: a meta-analysis of randomized controlled studies.
OBJECTIVE
To investigate whether the use of miniaturized cardiopulmonary bypass translates into decreased morbidity and mortality in patients having cardiac surgery.


METHODS
We independently conducted a systematic review and meta-analysis of data pooled from existing trials listed in PubMed and conference proceedings. Sixteen studies were identified, including 1619 patients having cardiac surgery. Inclusion criteria were random allocation to treatment and comparison of a miniaturized cardiopulmonary bypass system versus conventional cardiac surgery. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The end points were the rate of neurologic and myocardial damage and the number of patients transfused.


RESULTS
Miniaturized cardiopulmonary bypass was associated with significant reductions of neurologic damage (4/548 [0.7%] vs 19/555 [3.4%], odds ratio = 0.30 [0.12-0.73], P = .008), reduction in peak cardiac troponin (weighted mean difference = -0.15 ng/dL [-0.18, -0.11], P < .001), and in the number of transfused patients (55/552 [9.9%] vs 101/563 [17.9%], odds ratio = 0.42 [0.28-0.63], P < .001). No difference in mortality was noted (8/758 [1.0%] vs 14/771 [1.8%], odds ratio = 0.60 [0.26-1.39]).


CONCLUSIONS
Miniaturized cardiopulmonary bypass has beneficial effects resulting in decreased transfusion rate and cardiac and neurologic damage.
Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
Alberto
A
Zangrillo
Francesco Alfredo
FA
Garozzo
Giuseppe
G
Biondi-Zoccai
Federico
F
Pappalardo
Fabrizio
F
Monaco
Martina
M
Crivellari
Elena
E
Bignami
Massimiliano
M
Nuzzi
Giovanni
G
Landoni
D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004867:Equipment Design; D019317:Evidence-Based Medicine; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008904:Miniaturization; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome