Invited commentary

Abstract

This report describes initial results with a new pump-oxygenator circuit. The circuit has a low priming volume and the components are small enough that the entire system can be positioned in close proximity to the patient. The net result is substantially decreased hemodilution. The effect of the heparin-coated surfaces and oxygenator design on decreasing complement activation and other immunologically-mediated adverse events was not directly evaluated.Although this small series did not provide data robust enough to recommend routine use of the system, the data are sufficiently interesting to stimulate further investigation. Of note, the authors mentioned several potential complications of the MECC system that are serious and might prove fatal. These include air embolism and sudden decrease or loss of flow due to interruption of venous inflow in the absence of a venous reservoir. It is also clear from this report that a dedicated team effort is needed to use this system safely and effectively.The balance of benefit to risk as well as cost for the MECC system versus conventional CPB or off-pump techniques remains to be clearly defined, as do its indications for use. Results of this system used in patients who are at risk for the adverse effects of CPB (eg, adults with severe pulmonary disease or infants) will be particularly interesting. This report describes initial results with a new pump-oxygenator circuit. The circuit has a low priming volume and the components are small enough that the entire system can be positioned in close proximity to the patient. The net result is substantially decreased hemodilution. The effect of the heparin-coated surfaces and oxygenator design on decreasing complement activation and other immunologically-mediated adverse events was not directly evaluated. Although this small series did not provide data robust enough to recommend routine use of the system, the data are sufficiently interesting to stimulate further investigation. Of note, the authors mentioned several potential complications of the MECC system that are serious and might prove fatal. These include air embolism and sudden decrease or loss of flow due to interruption of venous inflow in the absence of a venous reservoir. It is also clear from this report that a dedicated team effort is needed to use this system safely and effectively. The balance of benefit to risk as well as cost for the MECC system versus conventional CPB or off-pump techniques remains to be clearly defined, as do its indications for use. Results of this system used in patients who are at risk for the adverse effects of CPB (eg, adults with severe pulmonary disease or infants) will be particularly interesting.