Initial experience with minimally invasive extracorporeal circulation in coronary artery bypass graft reoperations

Heinisch, Paul Philipp; Mihalj, Maks; Haliguer, Elif; Gahl, Brigitta; Winkler, Bernhard; Venetz, Philipp; Jenni, Hansjoerg; Schober, Patrick; Erdoes, Gabor; Luedi, Markus M.; Schefold, Joerg C.; Kadner, Alexander; Huber, Christoph; Carrel, Thierry P. (2022). Initial experience with minimally invasive extracorporeal circulation in coronary artery bypass graft reoperations. Swiss medical weekly, 152(w30101), w30101. EMH Media 10.4414/smw.2022.w30101

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AIMS OF THE STUDY

Minimally invasive extracorporeal circulation (MiECC) is an established alternative to conventional extracorporeal circulation (CECC) in coronary artery bypass graft surgery (CABG), but data on its use in cardiac reoperations are limited. We aimed to analyse perioperative morbidity and mortality in adult patients undergoing reoperations for isolated CABG using either CECC or MiECC circuits at our centre.

METHODS AND RESULTS

In a single centre retrospective observational study of all adult patients undergoing cardiac reoperations for isolated CABG between 2004 and 2016, we identified 310 patients, and excluded those who received concomitant cardiac procedures (n = 205). Of the remaining 105 patients, 47 received isolated redo-CABG using MiECC, and 58 received CECC. Propensity score modelling was performed, and inversed probability treatment analysis was used between the treatment groups. Primary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiac or cerebrovascular events or need for conversion to CECC. Groups were comparable, apart from a higher incidence of NYHA class III or higher in CECC group (33.5% vs 8.6%, p= 0.004). Shorter times for operation, cardiopulmonary bypass and aortic cross-clamp were observed in the MiECC group. The incidence of postoperative atrial fibrillation was significantly lower with MiECC (22.1%, p = 0.012). No significant difference was observed in all-cause 30-day mortality between the MiECC and CECC groups (6.8% vs. 8.3%, p = 0.81).

CONCLUSION

We found no difference in overall mortality between CECC and MiECC in patients undergoing reoperation for isolated CABG. Furthermore, we found no indication of differences in most outcomes between extracorporeal circuit types. In the case of redo-CABG, MiECC could provide an alternative strategy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Heinisch, Paul Philipp, Mihalj, Maks, Gahl, Brigitta, Jenni, Hansjoerg, Erdoes, Gabor (B), Lüdi, Markus, Schefold, Jörg Christian, Kadner, Alexander, Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1424-3997

Publisher:

EMH Media

Language:

English

Submitter:

Pubmed Import

Date Deposited:

24 Feb 2022 10:16

Last Modified:

29 Mar 2023 23:38

Publisher DOI:

10.4414/smw.2022.w30101

PubMed ID:

35195525

BORIS DOI:

10.48350/165980

URI:

https://boris.unibe.ch/id/eprint/165980

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