跳至主要内容

Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting

Read full paper at:
http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52444#.VJjCicCAM4

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.
Cite this paper
Emerson, D. , Baldwin, D. , Pinales, M. , Greenberg, M. , Mattes, M. and Trachiotis, G. (2014) Experience with Miniaturized Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Comparison of the NovoSCI Ready System to Off-Pump and Conventional Coronary Artery Bypass Grafting. World Journal of Cardiovascular Surgery, 4, 232-238. doi: 10.4236/wjcs.2014.412034. 
 

[1] Gibbon Jr., J.H. (1954) Application of a Mechanical Heart and Lung Apparatus to Cardiac Surgery. Minnesota Medicine, 37, 171-185.
[2] Edwards, F.H., Clark, R.E. and Schwartz, M. (1994) Coronary Artery Bypass Grafting: The Society of Thoracic Surgeons National Database Experience. The Annals of Thoracic Surgery, 57, 12-19.
http://dx.doi.org/10.1016/0003-4975(94)90358-1
[3] Fitzgibbon, G.M., Kafka, H.P., Leach, A.J., Keon, W.J., Hooper, G.D. and Burton, J.R. (1996) Coronary Bypass Graft Fate and Patient Outcome: Angiographic Follow-Up of 5,065 Grafts Related to Survival and Reoperation in 1,388 Patients during 25 Years. Journal of the American College of Cardiology, 28, 616-626.
http://dx.doi.org/10.1016/0735-1097(96)00206-9
[4] Liebold, A., Keyl, C. and Birnbaum, D.E. (1999) The Heart Produces but the Lungs Consume Proinflammatory Cytokines Following Cardiopulmonary Bypass. European Journal Cardio-Thoracic Surgery, 15, 340-345.
http://dx.doi.org/10.1016/S1010-7940(99)00038-X
[5] Wendel, H.P. and Ziemer, G. (1999) Coating-Techniques to Improve the Hemocompatibility of Artificial Devices Used for Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 16, 342-350.
http://dx.doi.org/10.1016/S1010-7940(99)00210-9
[6] Kirklin, J.K., Westaby, S., Blackstone, E.H., Kirklin, J.W., Chenoweth, D.E. and Pacifico, A.D. (1983) Complement and the Damaging Effects of Cardiopulmonary Bypass. The Journal of Thoracic and Cardiovascular Surgery, 86, 845-857.
[7] Paparella, D., Yau, T.M. and Young, E. (2002) Cardiopulmonary Bypass Induced Inflammation: Pathophysiology and Treatment. An Update. European Journal Cardio-Thoracic Surgery, 21, 232-244.
http://dx.doi.org/10.1016/S1010-7940(01)01099-5
[8] Puskas, J.D. and Steele, M. (2007) Would You Like Some Cardiopulmonary Bypass with your Coronary Revascularization? Circulation, 116, 1756-1758.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.733089
[9] Wiesenack, C., Liebold, A., Philipp, A., Ritzka, M., Koppenberg, J., Birnbaum, D.E. and Keyl, C. (2004) Four Years’ Experience with a Miniaturized Extracorporeal Circulation System and Its Influence on Clinical Outcome. Artificial Organs, 28, 1082-1088.
http://dx.doi.org/10.1111/j.1525-1594.2004.00030.x
[10] Sakwa, M.P., Emery, R.W., Shannon, F.L., Altshuler, J.M., Mitchell, D., Zwada, D. and Holter, A.R. (2009) Coronary Artery Bypass Grafting with a Minimized Cardiopulmonary Bypass Circuit: A Prospective, Randomized Trial. The Journal of Thoracic and Cardiovascular Surgery, 137, 481-485.
http://dx.doi.org/10.1016/j.jtcvs.2008.08.057
[11] Remadi, J.P., Marticho, P., Butoi, I., Rakotoarivelo, Z., Trojette, F., Benamar, A., Beloucif, S., Foure, D. and Poulain, H.J. (2004) Clinical Experience with the Mini-Extracorporeal Circulation System: An Evolution or a Revolution? The Annals of Thoracic Surgery, 77, 2172-2175.
http://dx.doi.org/10.1016/S0003-4975(03)00977-9
[12] Liebold, A., Khosravi, A., Westphal, B., Skrabal, C., Choi, Y.H., Stamm, C., Kaminski, A., Alms, A., Birken, T., Zurakowski, D. and Steinhoff, G. (2006) Effect of Closed Minimized Cardiopulmonary Bypass on Cerebral Tissue Oxygenation and Microembolization. The Journal of Thoracic and Cardiovascular Surgery, 131, 268-276.
http://dx.doi.org/10.1016/j.jtcvs.2005.09.023
[13] Abdel-Rahman, U., Ozaslan, F., Risteski, P.S., Martens, S., Moritz, A., Al Daraghmeh, A., Keller, H. and Wimmer-Greinecker, G. (2005) Initial Experience with a Minimized Extracorporeal Bypass System: Is There a Clinical Benefit? The Annals of Thoracic Surgery, 80, 238-243.
http://dx.doi.org/10.1016/j.athoracsur.2005.02.032
[14] Beghi, C., Nicolini, F., Agostinelli, A., Borrello, B., Budillon, A.M., Bacciottini, F., Friggeri, M., Costa, A., Belli, L., Battistelli, L. and Gherli, T. (2006) Mini-Cardiopulmonary Bypass System: Results of a Prospective Randomized Study. The Annals of Thoracic Surgery, 81, 1396-400.
http://dx.doi.org/10.1016/j.athoracsur.2005.10.015
[15] Balachandran, S., Cross, M.H., Karthikeyan, S., Mulpur, A., Hansbro, S.D. and Hobson, P. (2002) Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit Reduces Blood Transfusion after Coronary Artery Surgery. The Annals of Thoracic Surgery, 73, 1912-1918.
http://dx.doi.org/10.1016/S0003-4975(02)03513-0
[16] Hsu, L.C. (1997) Biocompatibility in Cardiopulmonary Bypass. Journal of Cardiothoracic and Vascular Anesthesia, 11, 376-382.
http://dx.doi.org/10.1016/S1053-0770(97)90108-7
[17] Palatianos, G.M., Foroulis, C.N., Vassili, M.I., Astras, G., Triantafillou, K., Papadakis, E., Lidoriki, A.A., Iliopoulou, E. and Melissari, E.N. (2003) A Prospective, Double-Blind Study on the Efficacy of the Bioline Surface-Heparinized Extracorporeal Perfusion Circuit. The Annals of Thoracic Surgery, 76, 129-135.
http://dx.doi.org/10.1016/S0003-4975(03)00338-2
[18] Ovrum, E., Mollnes, T.E., Fosse, E., Holen, E.A., Tangen, G., Abdelnoor, M., Ringdal, M.A., Oystese, R. and Venge, P. (1995) Complement and Granulocyte Activation in Two Different Types of Heparinized Extracorporeal Circuits. The Journal of Thoracic and Cardiovascular Surgery, 110, 1623-1632.
http://dx.doi.org/10.1016/S0022-5223(95)70023-4
[19] Fromes, Y., Gaillard, D., Ponzio, O., Chauffert, M., Gerhardt, M.F., Deleuze, P. and Bical, O.M. (2002) Reduction of the Inflammatory Response Following Coronary Bypass Grafting with Total Minimal Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 22, 527-533.
http://dx.doi.org/10.1016/S1010-7940(02)00372-X
[20] Koch, C.G., Li, L., Duncan, A.I., Mihaljevic, T., Cosgrove, D.M., Loop, F.D., Starr, N.J. and Blackstone, E.H. (2006) Morbidity and Mortality Risk Associated with Red Blood Cell and Blood-Component Transfusion in Isolated Coronary Artery Bypass Grafting. Critical Care Medicine, 34, 1608-1616.
http://dx.doi.org/10.1097/01.CCM.0000217920.48559.D8
[21] Koch, C.G., Li, L., Duncan, A.I., Mihaljevic, T., Loop, F.D., Starr, N.J. and Blackstone, E.H. (2006) Transfusion in Coronary Artery Bypass Grafting Is Associated with Reduced Long-Term Survival. The Annals of Thoracic Surgery, 81, 1650-1657.
http://dx.doi.org/10.1016/j.athoracsur.2005.12.037
[22] Fromes, Y., Gaillard, D., Ponzio, O., Chauffert, M., Gerhardt, M.F., Deleuze, P. and Bical, O.M. (2002) Reduction of the Inflammatory Response Following Coronary Bypass Grafting with Total Minimal Extracorporeal Circulation. European Journal Cardio-Thoracic Surgery, 22, 527-533.
http://dx.doi.org/10.1016/S1010-7940(02)00372-X
[23] Harling, L., Warren, O.J., Martin, A., Kemp, P.R., Evans, P.C., Darzi, A. and Athanasiou, T. (2011) Do Miniaturized Extracorporeal Circuits Confer Significant Clinical Benefit without Compromising Safety? A Meta-Analysis of Randomized Controlled Trials. ASAIO Journal, 57, 141-151.
http://dx.doi.org/10.1097/MAT.0b013e318209d63b
[24] Formica, F., Broccolo, F., Martino, A., Sciucchetti, J., Giordano, V., Avalli, L., Radaelli, G., Ferro, O., Corti, F., Cocuzza, C. and Paolini, G. (2009) Myocardial Revascularization with Miniaturized Extracorporeal Circulation versus Off Pump: Evaluation of Systemic and Myocardial Inflammatory Response in a Prospective Randomized Study. The Journal of Thoracic and Cardiovascular Surgery, 137, 1206-1212.
http://dx.doi.org/10.1016/j.jtcvs.2008.09.074              eww141223lx
标签：

评论

发表评论

此博客中的热门博文

Does Immigration Promote the Investment of the Monopolistic Firm?

In the present paper, we examine the effect of increasing uncertainty of immigrants’ growth on the optimal timing of investment of a firm that has a monopolistic power over the labor market. It is revealed that when the uncertainty of immigrants’ growth is more than a threshold level, increasing uncertainty of immigrants’ growth accelerates the optimal timing of firms’ investment and enhances the economic growth, even if the uncertainty of immigrants’ growth is formulated by the geometric Brownian motion, which is in sharp contrast to the standard result that an increase in the uncertainty postpones the optimal timing. With an increase in the immigrants over the past ten years, workforces in the host countries have been growing significantly to the extent that the immigrants represent 70% of the increase in the workforce in Europe, and 47% in the United States as OECD indicates. In the present paper, we attempted to investigate the effect of increased uncertainty caused by the growi...
发表评论
阅读全文

Education Policy Implementation: A Mechanism for Enhancing Primary Education Development in Zanzibar

Education is one of the fundamental rights of individuals; therefore, the government of a country needs to develop and strengthen educational policy and quality as well as to ensure that everyone has equal access to basic education. The improvement of access and quality of education in the world is becoming as an essential factor in development, whereas the basic education (primary school), is acknowledged as a foundation of the higher educational development for every country. To fulfill this goal, governments introduce several policies and procedures; however, it requires some reforms and participation from the politician, policymakers, and other stakeholders to re-examine educational policy so that it can lead to multiplication and betterment of the reforms. Educational reforms actually focus on accountability. A positive educational development and reform is very challenging and needs more effort and strategy on how to use and utilize the resources effectively as such it can achie...
发表评论
阅读全文