A retrospective comparative study of minimally invasive extracorporeal circulation versus conventional extracorporeal circulation in emergency coronary artery bypass surgery patients: a single surgeon analysis.
OBJECTIVE
At the moment, the main application of minimally invasive extracorporeal circulation (MiECC) is reserved for elective cardiac operations such as coronary artery bypass grafting (CABG) and/or aortic valve replacement. The purpose of this study was to compare the outcome of emergency CABG operations using either MiECC or conventional extracorporeal circulation (CECC) in patients requiring emergency CABG with regard to the perioperative course and the occurrence of major adverse cardiac and cerebral events (MACCE).


METHODS
We analysed the emergency CABG operations performed by a single surgeon, between January 2007 and July 2013, in order to exclude the differences in surgical technique. During this period, 187 emergency CABG patients (113 MiECC vs 74 CECC) were investigated retrospectively with respect to the following parameters: in-hospital mortality, MACCE, postoperative hospital stay and perioperative transfusion rate.


RESULTS
The mean logistic European System for Cardiac Operative Risk Evaluation was higher in the CECC group (MiECC 12.1 ± 16 vs CECC 15.0 ± 20.8, P = 0.15) and the number of bypass grafts per patient was similar in both groups (MiECC 2.94 vs CECC 2.93). There was no significant difference in the postoperative hospital stay or in major postoperative complications. The in-hospital mortality was higher in the CECC group 6.8% versus MiECC 4.4% (P = 0.48). The perioperative transfusion rate was lower with MiECC compared with CECC (MiECC 2.6 ± 3.2 vs CECC 3.8 ± 4.2, P = 0.025 units of blood per patient).


CONCLUSIONS
In our opinion, the use of MiECC in urgent CABG procedures is safe, feasible and shows no disadvantages compared with the use of CECC. Emergency operations using the MiECC system showed a significantly lower blood transfusion rate and better results concerning the unadjusted in-hospital mortality.
Department of Cardiovascular Surgery, MediClin Heart Centre Coswig, Coswig, Germany magda_rufa@yahoo.com.
Magdalena
M
Rufa
Department of Cardiovascular Surgery, MediClin Heart Centre Coswig, Coswig, Germany.
Jens
J
Schubel
Department of Cardiovascular Perfusion, MediClin Heart Centre Coswig, Coswig, Germany.
Christian
C
Ulrich
Department of Cardiovascular Perfusion, MediClin Heart Centre Coswig, Coswig, Germany.
Jan
J
Schaarschmidt
Institute of Infectious Diseases 'Prof. Dr. Matei Bals', Bucharest, Romania.
Catalin
C
Tiliscan
Department of Cardiovascular Perfusion, MediClin Heart Centre Coswig, Coswig, Germany Department of Clinical Medicine, Aarhus University, MediClin Heart Centre Coswig, Coswig, Germany.
Adrian
A
Bauer
Department of Cardiovascular Surgery, MediClin Heart Centre Coswig, Coswig, Germany.
Harald
H
Hausmann
D000368:Aged; D001803:Blood Transfusion; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Acute myocardial infarction; Emergency coronary artery bypass surgery; Minimally invasive extracorporeal circulation