Miniaturized versus conventional cardiopulmonary bypass in high-risk patients undergoing coronary artery bypass surgery.
OBJECTIVE
To review our results with the use of miniaturized cardiopulmonary bypass (Mini-CPB) versus conventional cardiopulmonary bypass (C-CPB) in high-risk patients (additive EuroSCORE>or=6) who have undergone coronary artery bypass graft surgery (CABG).


METHODS
This study includes a consecutive series of 236 patients with an additive EuroSCORE>or=6 who underwent CABG, employing either C-CPB or Mini-CPB. Propensity score analysis was performed.


RESULTS
The study groups had similar EuroSCOREs. Stroke rate was significantly higher among C-CPB patients (5.4% vs. 0%, p=0.026). In-hospital mortality (4.8% vs. 3.4%, p=0.75) and combined adverse end-point rate were higher in C-CPB patients (20.4% vs. 13.5%, p=0.18). Postoperative bleeding and need for transfusion were similar in the study groups, but re-sternotomy for bleeding was more frequent among C-CPB patients (4.8% vs. 1.1%, p=0.26). Seventy-four propensity matched pairs had similar immediate postoperative results: C-CPB patients had higher mortality (6.8% vs. 4.1%, p=0.72), stroke (5.4% vs. 0%, p=0.12) and combined adverse end-point rates (27.0% vs. 16.2%, p=0.11), but such differences failed to reach statistical significance.


CONCLUSIONS
Mini-CPB achieved somewhat better results than C-CPB in these high-risk patients undergoing isolated CABG. This study confirmed that cerebral protection could be the main benefit associated with the use of Mini-CPB.
Koivisto
Simo-Pekka
SP
Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland.
Wistbacka
Jan-Ola
JO
Rimpiläinen
Riikka
R
Nissinen
Juha
J
Loponen
Pertti
P
Teittinen
Kari
K
Biancari
Fausto
F
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000295:instrumentation* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008904:Miniaturization / Q000295:instrumentation* / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000401:mortality; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000401:mortality