Abstract
BackgroundThe impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial.MethodsA total of 348 patients underwent emergency CABG with MECC (n=146) or conventional extracorporeal circulation (CECC; n=175) between January 2005 and December 2010. Using propensity score matching after binary logistic regression, 100 patients, who underwent CABG with MECC could be matched with 100 patients, who underwent CABG with CECC. Primary outcome was 30-day mortality.ResultsUnadjusted 30-day mortality was 14.8% in patients with CECC and 6.9% in those with MECC (mean difference −7.9%; p=0.03). The adjusted mean difference (average treatment effect of the treated, ATT) after matching was −1.0% (95% CI −8.6 to 7.6; p=1.0). Intensive care unit stay (adjusted mean difference 1.0; 95% CI −0.2 to 3.2; p=0.70) and hospital stay (adjusted mean difference 1.0; 95% CI −2.0 to 3.6; p=0.40) did not show significant differences between both groups. The adjusted mean difference for postoperative low cardiac output syndrome was −1.1% (95% CI −7.3 to 7.1; p=0.83) without significant differences between CECC and MECC. Postoperative mechanical ventilation time, drain loss, postoperative rethoracotomy, postoperative neurological events, new onset renal replacement therapy and respiratory failure also had insignificant average treatment effects of the treated. In addition, all average treatment effects (ATEs) did not significantly differ between both groups.ConclusionUsing propensity score estimation and matching, we did not observe significant differences in terms of survival and further outcomes in patients who undergo emergency CABG with CECC or MECC, but our results call for further analysis.
Highlights
The impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial
Coronary artery bypass grafting (CABG) with cardiopulmonary bypass support (CPB) as standard perfusion technique remains the treatment of choice for high-grade left mainstem stenosis and triple-vessel coronary artery disease [1,2]
All operations were performed by six senior surgeons who are experienced in CABG with conventional as well as minimized extracorporeal circulation
Summary
The impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass support (CPB) as standard perfusion technique remains the treatment of choice for high-grade left mainstem stenosis and triple-vessel coronary artery disease [1,2]. Several studies compared the impact of minimized versus conventional extracorporeal circuits and found conflicting results. Various publications have reported that MECC decreases perioperative side effects such as systemic inflammation, coagulation derangement and postoperative complications [6,7,8], whereas other reports failed to confirm these promising results [9]. Our department has been performing CABG with MECC for more than one decade and we could demonstrate that MECC is a safe alternative for on-pump and off-pump coronary revascularization [10]. Even in high-risk patients MECC using could be successfully applied [11]
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