title: Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: what the evidence shows?
abstract: Recognition of the potentially deleterious effects of esxtracorporeal circulation led to off-pump coronary artery surgery (OPCAB) experiencing a surge in popularity in the initial decade after its conception. However, OPCAB has its own limitations and technical difficulties, such as coronary access, increased left ventricular size and reduced function, which may lead to the potential for suboptimal revascularization. As an alternative technique, miniaturized extracorporeal circulation (mECC) may provide a more controlled operative field in which the heart may be manipulated whilst minimizing the inflammatory, coagulopathic and haemodilutional effects of cardiopulmonary bypass. In this review, we outline the proposed benefits of the mECC system, discuss the pitfalls associated with mECC, and directly compare mECC to 'off-pump' coronary surgery for a variety of clinical and non-clinical outcomes.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK. leanne.harling@imperial.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Harling
authors.forename: P P
authors.initials: PP
authors.lastname: Punjabi
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006438:Hemodilution / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D008904:Miniaturization