Coronary artery bypass graft with minimal extracorporeal circulation.

BACKGROUND: To evaluate the advantages and benefits of a minimized extracorporeal circulation system in the performance of coronary artery bypass grafts.

METHODS: From September 2000 to February 2003, 279 consecutive patients underwent isolated coronary artery bypass grafting with minimal extracorporeal circulation. A group of 243 patients at good risk as defined by a Euro- SCORE of 3 underwent complete bypass and blood cardioplegia, and a high-risk group of 45 patients (EuroSCORE, 6) underwent operations with partial assistance and a beating heart. In a prospective substudy analysis of thrombocyte and platelet counts, transfusion requirements, PaO2/FIO2, leukocyte count, C-reactive protein level, postoperative bleeding, intensive care unit stay, and ventilation, 40 patients from the good-risk group were matched and compared with 40 patients who underwent operations with a conventional extracorporeal system.

RESULTS: Revascularization was complete with a mean of 2.8 distal anastomoses in the good-risk group and 2.4 in the high-risk group. Mortality rates were 1.2% and 4%, respectively. The system provided either complete or partial bypass assistance and depended on preload and afterload. The system also allowed easy access to all territories with perfect hemodynamic stability. Priming was reduced to 400 mL, and arterial and venous saturation monitoring revealed excellent maintenance of pH values. No complications or failure of the system occurred. Hemodilution, inflammatory response, and transfusion requirements were reduced in the minimal extracorporeal circulation group.

CONCLUSIONS: Minimal extracorporeal circulation allows minimal hemodilution and reduces transfusion requirements. The method allows safe and complete revascularization of either an arrested or a beating heart.