Chapter 33 - Miniaturizing cardiopulmonary bypass

Abstract

The evolution of minimal invasive extracorporeal circulation (MiECC) represents a major breakthrough in perfusion science. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. This is attributed mainly to MiECC unique characteristics, such as closed circuit with elimination of blood–air interaction, minimal hemodilution, biocompatible surfaces, and the exclusion of unprocessed shed blood reinfusion. Contemporary hybrid (modular) systems overcome any safety concern or technical difficulty; thus, enable performance of full-spectrum cardiac surgery. Consequently, MiECC translates into improved clinical benefit, which is evidenced by multiple clinical trials and meta-analyses. Furthermore, MiECC provides the basis for developing a multidisciplinary intraoperative strategy, which encompasses surgeon’s particular technique, goal-directed perfusion from perfusionist’s perspective, and point-of-care heparin/protamine and coagulation management from the anesthesiologist’s perspective. MiECC preserves integrity of microcirculation, which presumably translates into improved end-organ protection that explains most of its clinical benefits. Conclusively, MiECC represents the state-of-the-art in perfusion that should ultimately replace conventional cardiopulmonary bypass and become the standard practice in cardiac surgery.