Abstract
BackgroundPatients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (MiECC), particularly in end-stage coronary artery disease patients undergoing myocardial revascularization, have not been completely described.Materials and methodsIn this single-centre control study, 60 end-stage coronary artery disease patients undergoing isolated coronary artery bypass grafting (CABG) were included. Patients were divided into two groups of 30 patients each undergoing CABG using MiECC or conventional extracorporeal circulation (cECC).ResultsIn the MiECC group, oxygen delivery index (DO2i) was 305 mL/min/m2 in relation to indexed oxygen extraction ratio (O2ERi) 21.5%, whereas in the cECC group DO2i was 288 mL/min/m2 in relation to O2ERi 25.6% (p = 0.037). Lactate levels > 3 mmol/L were reported in 7 MiECC patients vs 20 cECC patients (p = 0.038), with blood glucose peak. Mean nadir hemoglobin values during cardiopulmonary bypass (CPB) were 9.7 g/dL in the MiECC group vs 7.8 g/dL in the cECC group (p = 0.044). Cardiac index during CPB was 2.4 L/min/m2 in both groups. Red blood cell units administered were 8 vs 21 units in the MiECC vs cECC group (p = 0.022). A glycemic peak was recorded in 7 patients of the MiECC group and in 20 patients of the cECC group (p = 0.037).ConclusionIn end-stage coronary artery disease, the MiECC technique was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cell unit administration and peak intraoperative lactate levels, which correlated with better postoperative outcome.
Highlights
Patients with coronary artery disease and concomitant heart failure requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality [1]
In end-stage coronary artery disease, the minimally invasive extracorporeal circulation (MiECC) technique was associated with a higher D O2i compared to conventional extracorporeal circulation (cECC)
MiECC patients showed a significant reduction in red blood cell unit administration and peak intraoperative lactate levels, which correlated with better postoperative outcome
Summary
Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction [LVEF] < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality [1]. In this population, the appropriate selection of perioperative techniques and strategies is crucial for the Condello et al Journal of Cardiothoracic Surgery (2021) 16:356 prevention of acute kidney injury (AKI) that frequently occurs after cardiopulmonary bypass (CPB). The benefits of minimally invasive extracorporeal circulation (MiECC), in end-stage coronary artery disease patients undergoing myocardial revascularization, have not been completely described
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