Abstract
The major source of morbidity following cardiopulmonary bypass (CPB) is the systemic inflammatory response (SIRS response) which leads to multiple derangements in different organ systems. To combat this, miniaturized cardiopulmonary bypass circuits (MCPBC) have been created to lessen the inflammatory response to CPB. Here we examine early outcomes following coronary artery bypass grafting (CABG) using a MCPBC system compared to conventional bypass techniques at a single institution. Methods: 60 consecutive patients undergoing elective CABG were prospectively enrolled. Nine patients underwent coronary artery bypass grafting (CABG) with conventional CPB (cCABG), 33 underwent off-pump CABG (OPCAB), and the remaining 18 patients underwent CABG with a MCPBC system. Demographics and outcomes were compared between groups and statistical analyses applied. Results: No significant difference was observed in mortality between groups, with only one death reported in total. Morbidity was also low, totaling only 6.7%, with none occurring in the MCPBC group. The MCPBC group required less PRBC and total blood product transfusion than the cCABG and OPCABG groups (p = 0.05), but changes in PLT and Hct over time were not different between groups. Conclusions: The MCPBC system was shown to be comparable to conventional bypass and OPCABG in terms of postoperative complications and mortality. Furthermore, the MCPBC system had the advantage of a decreased transfusion requirement. Based on our preliminary observations, this mini-cardiopulmonary bypass circuit provides a safe alternative to conventional bypass techniques.
Highlights
The development of cardiopulmonary bypass machines (CPB) in the 1950’s revolutionized the field of cardiac surgery [1], and for the first time allowed surgeons to directly address intracardiac disease processes
Coronary artery revascularization (CABG) can be performed with a mortality rate less than 3% [2] [3], using the gold-standard technique of coronary artery bypass grafting (CABG) with extracorporeal bypass. Despite these good outcomes, CABG procedures still have significant morbidities associated with them including bleeding, thromboembolic events, arrhythmias, neurological insults, and renal and hepatic dysfunction [4]-[6]. Many of these events occur as a direct result of the systemic inflammatory response syndrome (SIRS) that is caused by the use of CPB [7]
In an effort to reduce the negative effects of CPB, many strategies and concepts have evolved in the recent years, including the development of off-pump coronary bypass (OPCABG) to remove CPB from the procedure completely
Summary
Coronary artery revascularization (CABG) can be performed with a mortality rate less than 3% [2] [3], using the gold-standard technique of CABG with extracorporeal bypass Despite these good outcomes, CABG procedures still have significant morbidities associated with them including bleeding, thromboembolic events, arrhythmias, neurological insults, and renal and hepatic dysfunction [4]-[6]. Many of these events occur as a direct result of the systemic inflammatory response syndrome (SIRS) that is caused by the use of CPB [7]. Less than 25% of all CABG procedures are currently performed off-pump [8]
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