The benefits of minimized extracorporeal circulation (MECC) compared with conventional extracorporeal circulation (CECC) are still in debate.
Methods
PubMed, EMBASE and the Cochrane Library were searched until November 10, 2014. After quality assessment, we chose a fixed-effects model when the trials showed low heterogeneity, otherwise a random-effects model was used. We performed univariate meta-regression and sensitivity analysis to search for the potential sources of heterogeneity. Cumulative meta-analysis was performed to access the evolution of outcome over time.
Results
41 RCTs enrolling 3744 patients were included after independent article review by 2 authors. MECC significantly reduced atrial fibrillation (RR, 0.76; 95% CI, 0.66 to 0.89; P<0.001; I2 = 0%), and myocardial infarction (RR, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2 = 0%). In addition, the results regarding chest tube drainage, transfusion rate, blood loss, red blood cell transfusion volume, and platelet count favored MECC as well.
Conclusions
MECC diminished morbidity of cardiovascular complications postoperatively, conserved blood cells, and reduced allogeneic blood transfusion.
AnastasiadisK., AsteriouC., DeliopoulosA.Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures. Perfusion.2010; 25(4): 197–203.
2.
HarlingL., PunjabiP.P., AthanasiouT.Miniaturized extracorporeal circulation vs. off-pump coronary artery bypass grafting: what the evidence shows? Perfusion.2011; 26(Suppl 1): 40–47.
3.
TasdemirO., VuralK.M., KaragozH., BayazitK.Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases. J Thorac Cardiovasc Surg.1998; 116(1): 68–73.
4.
GodinhoA.S., AlvesA.S., PereiraA.J., PereiraT.S.On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis. Arq Bras Cardiol.2012; 98(1): 87–94.
5.
DonndorfP., KühnF., VollmarB.Comparing microvascular alterations during minimal extracorporeal circulation and conventional cardiopulmonary bypass in coronary artery bypass graft surgery: a prospective, randomized study. J Thorac Cardiovasc Surg.2012; 144(3): 677–683.
6.
YurukK., BezemerR., EuserM.The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg.2012; 15(3): 364–370.
7.
AnastasiadisK., AntonitsisP., HaidichA.B., ArgiriadouH., DeliopoulosA., PapakonstantinouC.Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials. Int J Cardiol.2013; 164(2): 158–169.
8.
HarlingL., WarrenO.J., MartinA.Do miniaturized extracorporeal circuits confer significant clinical benefit without compromising safety? A meta-analysis of randomized controlled trials. ASAIO J.2011; 57(3): 141–151.
9.
ZangrilloA., GarozzoF.A., Biondi-ZoccaiG.Miniaturized cardiopulmonary bypass improves short-term outcome in cardiac surgery: a meta-analysis of randomized controlled studies. J Thorac Cardiovasc Surg.2010; 139(5): 1162–1169.
10.
BiancariF., RimpiläinenR.Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart.2009; 95(12): 964–969.
11.
LiberatiA., AltmanD.G., TetzlaffJ.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol.2009; 62(10): e1–e34.
12.
BeggCBMM, MazumdarM.Operating characteristics of a rank correlation test for publication bias. Biometrics.1994; 50(4): 1088–1101.
13.
LauJ., AntmanE.M., Jimenez-SilvaJ., KupelnickB., MostellerF., ChalmersT.C.Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med.1992; 327(4): 248–254.
14.
FramesY., GaillardD., PonzioO.Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg.2002; 22(4): 527–533.
15.
RemadiJ.P., RakotoarivelloZ., MartichoP.Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial. J Thorac Cardiovasc Surg.2004; 128(3): 436–441.
16.
Abdel-RahmanU., ÖzaslanF., RisteskiP.S.Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit?Ann Thorac Surg.2005; 80(1): 238–243.
17.
ImmerF.F., PirovinoC., GygaxE., EnglbergerL., TevaearaiH., CarrelT.P.Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg.2005; 28(5): 701–704.
18.
NollertG., SchwabenlandI., MaktavD.Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammation and coagulation but loss of safety margins. Ann Thorac Surg.2005; 80(6): 2326–2332.
19.
WippermannJ., AlbesJ.M., HartrumpfM.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 Surg.2005; 28(1): 127–132.
20.
BeghiC., NicoliniF., AgostinelliA.Mini-cardiopulmonary bypass system: results of a prospective randomized study. Ann Thorac Surg.2006; 81(4): 1396–1400.
21.
KamiyaH., KofidisT., HaverichA., KlimaU.Preliminary experience with the mini-extracorporeal circulation system (Medtronic resting heart system). Interact Cardiovasc Thorac Surg.2006; 5(6): 680–682.
22.
LieboldA., KhosraviA., WestphalB.Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg.2006; 131(2): 268–276.
23.
RemadiJ.P., RakotoariveloZ., MartichoP., BenamarA.Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J.2006; 151(1): 198.
24.
SkrabalC.A., ChoiY.H., KaminskiA.Circulating endothelial cells demonstrate an attenuation of endothelial damage by minimizing the extracorporeal circulation. J Thorac Cardiovasc Surg.2006; 132(2): 291–296.
25.
CastiglioniA., VerziniA., PappalardoF.Minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement. Ann Thorac Surg.2007; 83(2): 586–591.
26.
HuybregtsR.A., MorariuA.M., RakhorstG.Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg.2007; 83(5): 1760–1766.
PerthelM., KlingbeilA., El-AyoubiL., GerickM., LaasJ.Reduction in blood product usage associated with routine use of mini bypass systems in extracorporeal circulation. Perfusion.2007; 22(1): 9–14.
ValtonenM., VähäsiltaT., Kaila-KeinänenT., KuttilaK.New mini-extracorporeal circulation system (ECC.O) is a safe technique in coronary surgery. Scand Cardiovasc J.2007; 41(5): 345–350.
31.
FarnetiP.A., SbranaS., SpillerD.Reduction of blood coagulation and monocyte-platelet interaction following the use of a minimal extracorporeal circulation system (Synergy) in coronary artery bypass grafting (CABG). Perfusion.2008; 23(1): 49–56.
32.
KofidisT., BarakiH., SinghH.The minimized extracorporeal circulation system causes less inflammation and organ damage. Perfusion.2008; 23(3): 147–151.
33.
OhataT., MitsunoM., YamamuraM.Beneficial effects of mini-cardiopulmonary bypass on hemostasis in coronary artery bypass grafting: analysis of inflammatory response and hemodilution. ASAIO J.2008; 54(2): 207–209.
34.
SchöttlerJ., LutterG., BöningA.Is there really a clinical benefit of using minimized extracorporeal circulation for coronary artery bypass grafting?Thorac Cardiovasc Surg.2008; 56(2): 65–70.
35.
CamboniD., SchmidtS., PhilippA.Microbubble activity in miniaturized and in conventional extracorporeal circulation. ASAIO J.2009; 55(1): 58–62.
36.
CastiglioniA., VerziniA., ColangeloN., NascimbeneS., LainoG., AlfieriO.Comparison of minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement: a randomized study. Interact Cardiovasc Thorac Surg.2009; 9(1): 37–41.
37.
GunaydinS., SariT., McCuskerK., SchonrockU., ZorlutunaY.Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function. Perfusion.2009; 24(3): 153–162.
38.
KutschkaI., SkorpilJ., El EssawiA., HajekT., HarringerW.Beneficial effects of modern perfusion concepts in aortic valve and aortic root surgery. Perfusion.2009; 24(1): 37–44.
39.
SakwaM.P., EmeryR.W., ShannonF.L.Coronary artery bypass grafting with a minimized cardiopulmonary bypass circuit: a prospective, randomized trial. J Thorac Cardiovasc Surg.2009; 137(2): 481–485.
40.
SvitekV., LonskyV., MandakJ.No clear clinical benefit of using mini-invasive extracorporeal circulation in coronary artery bypass grafting in low-risk patients. Perfusion.2009; 24(6): 389–395.
41.
BauerA., DiezC., SchubelJ.Evaluation of hemodynamic and regional tissue perfusion effects of minimized extracorporeal circulation (MECC). J Extra Corpor Technol.2010; 42(1): 30–39.
42.
SchoenebeckJ., HaddadM., WegscheiderK., Joubert-HuebnerE., ReichenspurnerH., DetterC.Prospective, randomized study comparing two different minimized versus conventional cardiopulmonary bypass systems. Innovations (Phila).2010; 5(4): 270–277.
AnastasiadisK., ArgiriadouH., KosmidisM.H.Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study. Heart.2011; 97(13): 1082–1088.
45.
El-EssawiA., HajekT., SkorpilJ.Are minimized perfusion circuits the better heart lung machines? Final results of a prospective randomized multicentre study. Perfusion.2011; 26(6): 470–478.
46.
RimpiläinenR., HautalaN., KoskenkariJ.Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery. Perfusion.2011; 26(6): 479–486.
47.
RimpiläinenR., HautalaN., KoskenkariJ.K.Minimized cardiopulmonary bypass reduces retinal microembolization: a randomized clinical study using fluorescein angiography. Ann Thorac Surg.2011; 91(1): 16–22.
48.
LiuY., TaoL., WangX., CuiH., ChenX., JiB.Beneficial effects of using a minimal extracorporeal circulation system during coronary artery bypass grafting. Perfusion.2012; 27(1): 83–89.
49.
SteinbrüchelA.S., JohanssonP.I., RafiqS., StensgaardJ., SteinbrüchelD.A.Equally increased hypercoagulability irrespective of using minimized or conventional ECC systems. Scand Cardiovasc J.2012; 46(4): 233–238.
50.
YurukK., BezemerR., EuserM.The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg.2012; 15(3): 364–370.
51.
AnastasiadisK., AsteriouC., AntonitsisP.Enhanced recovery after elective coronary revascularization surgery with minimal versus conventional extracorporeal circulation: a prospective randomized study. J Cardiothorac Vasc Anesth.2013; 27(5): 859–864.
52.
AsteriouC., AntonitsisP., ArgiriadouH.Minimal extracorporeal circulation reduces the incidence of postoperative major adverse events after elective coronary artery bypass grafting in high-risk patients. A single-institutional prospective randomized study. Perfusion.2013; 28(4): 350–356.
