title: The "benefits" of the mini-extracorporeal circulation in the minimal invasive cardiac surgery era.
abstract: Mini-extracorporeal circulation (MECC) constitutes a novel miniaturized cardiopulmonary bypass (CPB) circuit, heparin-coated and primed with aprotinin. Its membrane oxygenation is similar to conventional cardio-pulmonary bypass (CCPB), but it is a completely closed-volume system due to the lack of the venous reservoir which has been removed. In a mini circuit, the reservoir is the patient himself. Consequently, air entering the venous cannula is avoided. Nevertheless, the capabilities of MECC have been expanded either by the inclusion of a suction device that is only activated on direct contact with liquid in some circuits or by postoperative autotransfusion of the wrecked erythrocytes by a separate suction device with a cell-saver. Although the tubing diameter is similar between the two systems, the tubing length of the MECC is around half that of the CCPB, resulting in the restriction of priming volume. As a consequence, a higher hematocrit thus a limited need for perioperative blood transfusion is achieved due to less hemodilution. In addition, the inflammatory response is also diminished as a result of less artificial surface area interacting with blood. Finally, a lower dose of heparin is required prior to MECC than prior to CCPB.
authors.affiliation: Cardiac Surgery Department, Institut Mutualiste Montsouris, Paris, 75014, France. Electronic address: nikolaos.baikoussis@gmail.com.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Baikoussis
authors.affiliation: Cardiac Surgery Department, Ioannina University, School of Medicine, Ioannina, 45500, Greece.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papakonstantinou
authors.affiliation: Cardiac Surgery Department, Ioannina University, School of Medicine, Ioannina, 45500, Greece.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Apostolakis
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D007611:Aprotinin; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D006400:Hematocrit; D006438:Hemodilution; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D017202:Myocardial Ischemia / Q000517:prevention & control; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin; D007611:Aprotinin
keywords: Cardiopulmonary bypass; Extracorporeal circulation; Minimal extracorporeal circulation; Minimal invasive cardiac surgery; Off-pump coronary artery bypass