title: Minimally invasive versus conventional extracorporeal circulation in minimally invasive cardiac valve surgery.
abstract: BACKGROUND
  Minimally invasive extracorporeal circulation (MECC) technology was applied predominantly in coronary surgery. Data regarding the application of MECC in minimally invasive valve surgery are missing largely.
  
  
  METHODS
  Patients undergoing isolated minimally invasive mitral or aortic valve procedures were allocated either to conventional extracorporeal circulation (CECC) group (n = 63) or MECC group (n = 105), and their prospectively generated data were analyzed.
  
  
  RESULTS
  Demographic data were comparable between the groups regarding age (CECC vs. MECC: 71.0 ± 7.5 vs. 66.2 ± 10.1 years, p = 0.091) and logistic EuroSCORE I (6.2 ± 2.5 vs. 5.4 ± 3.0, p = 0.707). Hospital mortality was one patient in each group (1.6 vs. 1.0%, p = 0.688). The levels of leukocytes were lower in the MECC group (11.6 ± 3.2 vs. 9.4 ± 4.3 109/L, p = 0.040). Levels of platelets (137.2 ± 45.5 vs. 152.4 ± 50.3 109/L, p = 0.015) and hemoglobin (103.3 ± 11.3 vs. 107.3 ± 14.7 g/L, p = 0.017) were higher in the MECC group. Renal function was better preserved (creatinine: 1.1 ± 0.4 vs. 0.9 ± 0.2 mg/dL, p = 0.019). We were able to validate shorter time of postoperative ventilation (9.5 ± 15.1 vs. 6.3 ± 3.4 h, p = 0.054) as well as significantly shorter intensive care unit (ICU) stay (1.8 ± 1.3 vs. 1.2 ± 1.0 d, p = 0.005) for MECC patients. The course of C-reactive protein did not differ between the groups.
  
  
  CONCLUSIONS
  We were able to prove the feasibility of MECC even in minimally invasive performed mitral and aortic valve procedures. In addition, the use of MECC provides decreased platelet consumption and less hemodilution. The use of MECC in these selected patients lead to a shorter ventilation time and ICU stay.
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Hardy
authors.initials: H
authors.lastname: Baumbach
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rustenbach
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Michaelsen
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Hipp
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Pressmar
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Leinweber
authors.affiliation: Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Ulrich Friedrich Wilhelm
authors.initials: UF
authors.lastname: Franke
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006438:Hemodilution; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome