Improved knowledge of the pathophysiological processes experienced in response to cardiopulmonary bypass has led to new developments in extracorporeal technology and understanding. The use of mini extracorporeal circuits (MECC) is rapidly expanding in clinical practice. The mini extracorporeal circuit differs by a greatly reduced tubing length and the number of components when compared with current circuit designs. The MECC is believed to offer potential benefits to the surgical patient by reducing the systemic inflammatory response that remains strongly implicated in post-operative organ dysfunction. We present a review of the available literature and find the MECC to show an acceptable safety profile with a reduction in post-operative complications and transfusion requirements and no evidence of any negative impairment to the surgeon, anaesthetist or perfusionist. The observed post-bypass inflammatory response is seen to be lower after MECC bypass and this is of clear clinical benefit.
Fromes Y., Gaillard D., Ponzio O., et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothoracic Surg2002; 22(4): 527-533.
2.
Gerritsen WB , van Boven WJ, Wesselink RM, et al. Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation. Transfus Med2006; 16(5): 329-334.
3.
Beghi C., Nicolini F., Agostinelli A., et al. Mini-cardiopulmonary bypass system: results of a prospective randomised study. Ann Thoracic Surgery2006 ; 81(4): 1396-1400.
4.
Remadi JP, Marticho P., Butoi I., et al. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution? Ann Thoracic Surgery2004; 77(6): 2172-2175.
5.
Stalder M., Gygax E., Immer FF, Englberger L., Tevaearai H., Carrel TPMinimised cardiopulmonary bypass combined with a smart suction device: the future of cardiopulmonary bypass?Heart Surg Forum2007; 10(3): 170-173.
6.
Lilly K., O’Gara PJ, Treanor PR, et al. Cardiopulmonary bypass: it’s not the size, it’s how you use it! Review of a comprehensive blood conservation strategy. J Extra Corporeal Tech2004; 3(36): 263-268.
7.
Remadi JP, Rakotoarivelo Z., Marticho P., Benamar. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J2006; 151(1): 198.
8.
Raja S., Dreyfus G.Modulation of systemic inflammatory response after cardiac surgery. Asian Cardiovasc Thoracic Ann2005; 13(4): 382-395.
9.
Wippermann J. , Albes JM, Hartrumpf M., et al. Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system. Eur J Cardiothorac Surg2005; 28(1): 127-132.
10.
Fayad G., Modine T., Naja G., et al. Second generation of minimal invasive extracorporeal circuit: pilot study resting heart system. J Extra Corpor Technol2005; 37(4): 387-389.
11.
Nollert G., Schwabenland I., Maktav D., et al. Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammatory and coagulation but no loss on safety margins. Ann Thoracic Surg2005; 80: 1952-1953.
12.
Perthel M., Kseibi S., Sagebiel F., Alken A., Laas J.Comparison of conventional extracorporeal circulation and minimal extracorporeal circulation with respect to microbubbles and microembolic signals. Perfusion2005; 20(6): 329-333.
13.
Remadi JP, Rakotoarivello Z., Marticho P., et al. Aortic valve replacement with the minimal extracorporeal circulation versus standard cardiopulmonary bypass: a randomised prospective trial. J Thorac Cardiovasc Surg2004; 128(3): 436-441.
14.
Palombo D., Valenti D., Gaggiano A., Lupo M., Borin P.Early experience with the minimal extracorporeal circulation system (MECC) during thoracoabdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg2004; 27(3): 324-326
15.
Mulholland JW, Anderson JR, Yarham GJ, Tuladhur S., Saed I., Oliver MDMiniature cardiopulmonary bypass- the Hammersmith experience. Perfusion2007; 22: 161-166.
16.
Immer FF, Pirovino C., Gygax E., Englberger L., Tevaearai H., Carrel TPMinimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg2005; 28(5): 701-704.
17.
Vaislic C., Bical O., Farge C., et al. Totally minimized extracorporeal circulation: an important benefit for coronary artery bypass grafting in Jehovah’s witnesses. Heart Surg Forum2003; 6(5): 307-310.
Skrabal CA, Steinhoff G., Liebold A.Minimizing cardiopulmonary bypass attenuates myocardial damage after cardiac surgery. ASAIO J2007 Jan-Feb; 53(1): 332-335
20.
Skrabal CA, Choi YH, Kaminski A., et al. Circulating endothelial cells demonstrate an attenuation of endothelial damage by minimizing the extracorporeal circulation. J Thorac Cardiovasc Surg2006Aug; 132(2): 291-296.
21.
Liebold A., Khosravi A., Westphal B., et al. Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg2006; 131(2): 268-276.
22.
Wiesenack C. , Liebold A., Philipp A., et al. Four years’ experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs2004; 28(12): 1082-1088.
23.
Aldea GS, Soltow LO, Chandler WL, et al. Limitation of thrombin generation, platelet activation, and inflammation by elimination of cardiotomy suction in patients undergoing coronary artery bypass grafting treated with heparin-bonded circuits. J Thorac Cardiovasc Surg2002; 123: 742-755.
24.
Westerberg M., Bengtsson A., Jeppson A.Coronary surgery without cardiotomy suction and autotransfusion reduces the post-operative inflammatory response. Ann Thorac Surg2004; 78: 54-59.
25.
Mazzone A., De Servi S., Mazzucchelli I., et al. Increased concentrations of inflammatory mediators in unstable angina: correlation with serum troponin T. Heart2001; 85: 571-575.
26.
De Servi S. , Mariani M., Mariani G., Mazzone A.C-reactive protein increase in unstable coronary disease cause or effect?J Am Coll Cardiol2005; 46: 1496-1502.
27.
Manginas A. , Bei E., Chaidaroglou A., et al. Peripheral levels of matrix metalloproteinase-9, interleukin-6, and C-reactive protein are elevated in patients with acute coronary syndromes: correlations with serum troponinI. Clin Cardiol2005; 28: 182-186.
