Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization
Abstract Background Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (Mi...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-021-01735-0 |
| _version_ | 1819283465166651392 |
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| author | Ignazio Condello Giuseppe Santarpino Francesco Bartolomucci Giovanni Valenti Nicola Di Bari Marco Moscarelli Vincenza Vitobello Vera Triggiani Mario Gaudino Flavio Rimmaudo Giuseppe Speziale Giuseppe Nasso |
| author_facet | Ignazio Condello Giuseppe Santarpino Francesco Bartolomucci Giovanni Valenti Nicola Di Bari Marco Moscarelli Vincenza Vitobello Vera Triggiani Mario Gaudino Flavio Rimmaudo Giuseppe Speziale Giuseppe Nasso |
| author_sort | Ignazio Condello |
| collection | DOAJ |
| description | Abstract Background Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (MiECC), particularly in end-stage coronary artery disease patients undergoing myocardial revascularization, have not been completely described. Materials and methods In this single-centre control study, 60 end-stage coronary artery disease patients undergoing isolated coronary artery bypass grafting (CABG) were included. Patients were divided into two groups of 30 patients each undergoing CABG using MiECC or conventional extracorporeal circulation (cECC). Results In the MiECC group, oxygen delivery index (DO2i) was 305 mL/min/m2 in relation to indexed oxygen extraction ratio (O2ERi) 21.5%, whereas in the cECC group DO2i was 288 mL/min/m2 in relation to O2ERi 25.6% (p = 0.037). Lactate levels > 3 mmol/L were reported in 7 MiECC patients vs 20 cECC patients (p = 0.038), with blood glucose peak. Mean nadir hemoglobin values during cardiopulmonary bypass (CPB) were 9.7 g/dL in the MiECC group vs 7.8 g/dL in the cECC group (p = 0.044). Cardiac index during CPB was 2.4 L/min/m2 in both groups. Red blood cell units administered were 8 vs 21 units in the MiECC vs cECC group (p = 0.022). A glycemic peak was recorded in 7 patients of the MiECC group and in 20 patients of the cECC group (p = 0.037). Conclusion In end-stage coronary artery disease, the MiECC technique was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cell unit administration and peak intraoperative lactate levels, which correlated with better postoperative outcome. |
| first_indexed | 2024-12-24T01:31:54Z |
| format | Article |
| id | doaj.art-3228d4bac4f1407785b318d40b360b76 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-24T01:31:54Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-3228d4bac4f1407785b318d40b360b762022-12-21T17:22:18ZengBMCJournal of Cardiothoracic Surgery1749-80902021-12-011611710.1186/s13019-021-01735-0Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularizationIgnazio Condello0Giuseppe Santarpino1Francesco Bartolomucci2Giovanni Valenti3Nicola Di Bari4Marco Moscarelli5Vincenza Vitobello6Vera Triggiani7Mario Gaudino8Flavio Rimmaudo9Giuseppe Speziale10Giuseppe Nasso11Department of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalASL BATASL BATDivision of Cardiac Surgery, Dipartimento di Emergenza e Trapianti di Organo (D.E.T.O.), University of BariDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiothoracic Surgery, Weill Cornell MedicineDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalDepartment of Cardiac Surgery, Perfusion Service, GVM Care and Research, Anthea HospitalAbstract Background Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality. The benefits of minimally invasive extracorporeal circulation (MiECC), particularly in end-stage coronary artery disease patients undergoing myocardial revascularization, have not been completely described. Materials and methods In this single-centre control study, 60 end-stage coronary artery disease patients undergoing isolated coronary artery bypass grafting (CABG) were included. Patients were divided into two groups of 30 patients each undergoing CABG using MiECC or conventional extracorporeal circulation (cECC). Results In the MiECC group, oxygen delivery index (DO2i) was 305 mL/min/m2 in relation to indexed oxygen extraction ratio (O2ERi) 21.5%, whereas in the cECC group DO2i was 288 mL/min/m2 in relation to O2ERi 25.6% (p = 0.037). Lactate levels > 3 mmol/L were reported in 7 MiECC patients vs 20 cECC patients (p = 0.038), with blood glucose peak. Mean nadir hemoglobin values during cardiopulmonary bypass (CPB) were 9.7 g/dL in the MiECC group vs 7.8 g/dL in the cECC group (p = 0.044). Cardiac index during CPB was 2.4 L/min/m2 in both groups. Red blood cell units administered were 8 vs 21 units in the MiECC vs cECC group (p = 0.022). A glycemic peak was recorded in 7 patients of the MiECC group and in 20 patients of the cECC group (p = 0.037). Conclusion In end-stage coronary artery disease, the MiECC technique was associated with a higher DO2i compared to cECC. MiECC patients showed a significant reduction in red blood cell unit administration and peak intraoperative lactate levels, which correlated with better postoperative outcome.https://doi.org/10.1186/s13019-021-01735-0Minimally invasive extracorporeal circulationMiECCEnd-stage coronary artery diseaseCoronary artery bypass grafting |
| spellingShingle | Ignazio Condello Giuseppe Santarpino Francesco Bartolomucci Giovanni Valenti Nicola Di Bari Marco Moscarelli Vincenza Vitobello Vera Triggiani Mario Gaudino Flavio Rimmaudo Giuseppe Speziale Giuseppe Nasso Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization Journal of Cardiothoracic Surgery Minimally invasive extracorporeal circulation MiECC End-stage coronary artery disease Coronary artery bypass grafting |
| title | Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization |
| title_full | Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization |
| title_fullStr | Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization |
| title_full_unstemmed | Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization |
| title_short | Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization |
| title_sort | minimally invasive extracorporeal circulation in end stage coronary artery disease patients undergoing myocardial revascularization |
| topic | Minimally invasive extracorporeal circulation MiECC End-stage coronary artery disease Coronary artery bypass grafting |
| url | https://doi.org/10.1186/s13019-021-01735-0 |
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