Clinical Application Of Minimized Cardiopulmonary Bypass Equipment During Minimally Invasive Cardiac Surgery

What Have We Known about Minimized Extracorporeal circulation versus Conventional Extracorporeal circulation? A Meta-analysis of Randomized Controlled TrialsObjective The benefits of minimized extracorporeal circulation (MECC) compared with conventional extracorporeal circulation (CECC) are still in debate. We performed a system review and meta-analysis to evaluate the evidence of protective effects owed to MECC.Methods We searched PubMed, EMBASE and Cochrane Library for relevant studies. Stata12.0was used to analysis-pooled results, heterogeneity searching and cumulative analysis for changes during time. To evaluate publication bias, visual observation of funnel plot, Egger’s test and Begg’s test were performed.Results41randomized controlled trials (RCTs) comparing MECC and CECC were retrieved from database searching, enrolling3202adult patients undergoing cardiac surgery. MECC significantly reduced transfusion rate (RR,0.5;95%CI,0.3to0.84; P=0.009; I2=68.6%), atrial fibrillation (RR,0.71;95%CI,0.58to0.86; P=0.001; I2=0%), and myocardial infarction (RR,0.458;95%CI,0.26to0.806; P=0.007; I2=0%). In addition, bleeding volume, fresh frozen plasma (FFP) transfusion volume, platelet count, red blood cell transfusion volume,1CU time, and cardiac troponin T (cTnT) were also reduced in MECC group. After meta-regression analysis, we found the trend that for patients with lower left ventricular ejection fraction (LVEF), the benefit of MECC for transfusion rate was more outstanding.Conclusion MECC did conserve blood cells, and reduce transfusion of blood production. It also reduced cardiovascular complications postoperatively. The results from meta-regression analysis showed that for patients in a more critical state, those patients who used MECC showed lower transfusion rate. Comparison the Effects of Three Cell Saver Devices on Erythrocyte Function during Cardiopulmonary Bypass ProcedureObjective Cell salvage devices are routinely used to process red blood cells (RBCs) shed during cardiac surgery. The purpose of this study was to evaluate three commercially available cell saver (CS) devices in terms of erythrocyte function and the quality of washed RBCs during cardiopulmonary bypass (CPB).Methods Thirty patients undergoing CPB were randomly allocated to three CS devices: Group C (Cell Saver5+; Haemonetics, n=10), Group M (Autolog; Medtronic, n=10), and Group F (CATS; Fresenius HemoCare, n=10). Blood samples were collected from reservoirs and transfusion bags. Reservoir’s and washed RBCs were analyzed for erythrocyte aggregation index (AI), deformation index(D1) and hematocrit viscosity (HV),2,3-diphosphoglycerate (2,3-DPG), hemotacrit (Hct), hemoglobin (Hb), free hemoglobin removal (△fHb), glucose (Glu), lactate (Lac), as well as blood urea nitrogen (BUN).Results After processing, Group C (P=0.026) and M (P=0.032) had relatively higher erythrocyte DI compare with Group F.Group C had lower△2,3-DPG compare with Group M (P=0.001)and F(P=0.001). Group F provides the maximal concentration of Hct (P=0.021;0.046) and Hb (P=0.008;0.013). In addition, Group C (P=0.035) and M (P=0.038) had the higher removal of fHb (△fHb) and had significant difference comparing with Group F.Conclusion CS devices use the same theory of centrifugation, however based on the different design, the function of the washed erythrocyte and undesirable content removal efficiency differs widely from one device to another. Preliminary Experiences with Minimal extracorporeal circulation:A Case SeriesObjective:This report summarizes the preliminary experiences of10cases with minimized extracorporeal circulation (MECC) in our hospital from July2012to August2012. Along with recent literature and progress in MECC, we aim to evaluate the safety and efficacy of MECC in minimally invasive cardiac surgery (MICS)Methods:Ten patients with application of MECC (experimental group) were analyzed in our institution retrospectively. Eight patients underwent traditional full median sternotomy coronary artery bypass grafting (CABG), and two patients underwent modified median mini-sternotomy aortic valve replacement (AVR). We report our MECC perfusion protocol; summarize the intraoperative managements and postoperative clinical outcomes compared with ten cases of conventional extracorporeal circulation (CECC)(control group)Results:All patients were discharged in the experimental group. Only one patient required perioperative blood transfusion. CPB time was93.7±19.9min, and aortic clamp time was54.8±18.5min. Preoperative mean hematocrit (HCT) was36.5±5.2%, mean HCT after neutralized was28.6±4.7%and mean HCT in ICU was33.5±2.8%. Duration of mechanical ventilation was14±5.7h, length of ICU stay was39.3±19.4h, and24hours chest tube drainage was424±156.2ml. Compared with CECC, there were no differences between the two groups except the aortic clamp time (P=0.021)Conclusions:Application of MECC is both safe and effective. As a complementary technology in MICS, MECC appears to play a more important role in reducing blood transfusion and improving clinical outcomes. Using VAVD Technique to achevie full flow femoral-femoral bypass during Vedio-assisted Cardiac SurgeryObjective:As minimally invasive cardiac surgery (MICS) became a trend and widely used, perfusion management improved a lot correspondingly. We reviewed the experience of our institue39cases patients underwent vedio-assisted cardiac surgery (VACS) with using different cannulation stratagy during cardiopulmonary bypass.Methods:From Jan17th2011to Mar6th2013, we performed39MICSs.33of the participants underwent atrial sepal defect closure,3underwent mitral valve replacement,2atrial septal defect closure combined tricuspid valve annuloplasty,1cor triatrium. Patients were assigned randomly into Group A(n=18), without VAVD; or Group B(n=21), with VAVD. Cardiopulmonary bypass (CPB) accomplished with peripheral cannulation. To exposure the operative field more clearly, we use uni-polar femoral vein tubes instead of double-polar ones in the latter25surgeries.Results:There was no in hospital death, and no reexploration for bleeding either.3in Group A had red blood cell infusion, no one in Group B had. The total volume of infused liquid in Group A was3382.26±1195.74ml, and in Group B was2471.95±823.29ml (P=0.008) There was no significant difference for other outcomes.Conclusion:The short-term outcomes of perfusion management during MICS were satisfied. To modify peripheral cannulation method and use VAVD can make the operation more safe and successful.