Abstract
The purpose of this study was to evaluate the safety and the clinical outcomes of aortic valve replacement (AVR) performed with minimally invasive extracorporeal circulation (miniECC) technique vs. standard cardiopulmonary bypass (CPB). From February 2006 to December 2007 a total of 181 isolated AVR were performed, of these 53 patients were operated using minimal extracorporeal circulation system and 128 patients were operated using the standard CPB. Demographic characteristics and operative data were similar in both groups except for EuroSCORE (P<0.0001). Operative mortality (<30 days) was 3.8% for miniECC group and 4.7% for CPB group (P=ns). Patients in both groups showed similar postoperative chest tube drainage (432+/-325 ml vs. 460+/-331 ml, P=ns). The percentage of transfused patients was similar in both groups (37.7% vs. 43.8%, P=0.45). The number of transfused blood bank products was higher in patients with a body surface area >1.7 m(2) and who underwent traditional CPB in respect to miniECC system. Postoperatively renal injury, atrial fibrillation episodes, neurologic event rate, ICU and hospital stay length were similar in both groups. The miniECC is suitable for AVR providing good clinical results but the present results should not identify the miniECC system to be superior to the conventional CPB.
Highlights
Cardiopulmonary bypass (CPB) induces global inflammatory reactions and induces coagulation disorders that may lead to an increased postoperative morbidity w1x
The preoperative hematocrit was a parameter that differed between groups
There were no cases of conversion from minimally invasive extracorporeal circulation (miniECC) to standard CPB
Summary
Cardiopulmonary bypass (CPB) induces global inflammatory reactions and induces coagulation disorders that may lead to an increased postoperative morbidity w1x. In coronary artery bypass grafting (CABG) procedures, the off-pump technique w2, 3x is used to prevent CPB-induced inflammatory response but in open-heart surgery this is still an outstanding problem. Cardiac surgery and CPB trigger a systemic inflammatory response largely caused by the contact of blood with foreign surfaces and recirculation of activated shed mediastinal blood w3, 4x. This inflammatory response may contribute to the development of postoperative complications, including respiratory failure, renal dysfunction, bleeding disorders, and multiple organ failure. Preventing these adverse inflammatory responses remains an important issue
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