title: Minimal extracorporeal circulation reduces the incidence of postoperative major adverse events after elective coronary artery bypass grafting in high-risk patients. A single-institutional prospective randomized study.
abstract: Coronary artery bypass grafting (CABG) using minimal extracorporeal circulation (MECC) has been associated with an improved short-term clinical outcome compared to conventional extracorporeal circulation (CECC). The aim of this study was to evaluate the impact of MECC compared to CECC on postoperative major adverse events in high-risk patients undergoing elective coronary revascularization procedures. Two hundred patients undergoing elective CABG were randomized into two groups. In Group A (n=100), MECC was used while Group B (n=100) included patients who were operated on CECC. The incidence of postoperative major adverse events (myocardial infarction, renal failure, stroke, death) was the primary end-point of the study. MECC was associated with a 77% relative risk reduction in the incidence of major adverse events compared to CECC (p=0.004). The rate of major adverse events occurring in the high-risk patient subgroup (preoperative left ventricular ejection fraction ≤40%, age >65 years, EuroSCORE II >5) operated on with MECC was significantly lower in comparison to their CECC counterparts. Based on our results, cardiac centres should be encouraged to use MECC as the standard circuit when performing elective coronary procedures, even in a high-risk population.
authors.affiliation: Department of Cardiothoracic Surgery, AHEPA University Hospital, 542 48, Thessaloniki, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Asteriou
authors.forename: P
authors.initials: P
authors.lastname: Antonitsis
authors.forename: H
authors.initials: H
authors.lastname: Argiriadou
authors.forename: A
authors.initials: A
authors.lastname: Deliopoulos
authors.forename: D
authors.initials: D
authors.lastname: Konstantinou
authors.forename: C
authors.initials: C
authors.lastname: Foroulis
authors.forename: C
authors.initials: C
authors.lastname: Papakonstantinou
authors.forename: K
authors.initials: K
authors.lastname: Anastasiadis
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005112:Extracorporeal Circulation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology; D020521:Stroke / Q000209:etiology; D015996:Survival Rate
keywords: coronary artery bypass grafting; extracorporeal circulation; myocardial infarction; randomized controlled trial; renal failure