NoBlood

Critical Care 2007, 11:R45

Minimally invasive cardiopulmonary bypass: does it really change the outcome?

Marco Ranucci and Giuseppe Isgrò
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Via Morandi 30, San Donato Milanese (Milan) – 20097, Italy

Abstract
Introduction
Many innovative cardiopulmonary bypass (CPB) systems have been recently proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study is aimed to verify the clinical impact of a MICPB in a large population of patients undergone coronary artery revascularization.
Methods
Retrospective analysis on 1,663 patients treated with a MICPB; the control group (conventional CPB) was extracted from a series of 2,877 patients according to a propensity score analysis.
Results
Patients receiving a MICPB had a shorter intensive care unit (ICU) stay, a lower peak postoperative serum creatinine and bilirubin level, and suffered less postoperative blood loss. Within a multivariable model MICPB is independently associated with a lower rate of atrial fibrillation (odds ratio 0.83, 95% confidence interval 0.69-0.99) and ventricular arrhythmias (odds ratio 0.45, 95% confidence interval 0.28-0.73); and with higher rates of early discharge from the ICU (odds ratio 1.31, 95% confidence interval 1.06-1.6) and from the Hospital (odds ratio 1.46, 95% confidence interval 1.18-1.8). Hospital mortality did not differ between groups.
Conclusion
MICPBs are associated with a reduced morbidity; however, these results should be confirmed in a large prospective randomized controlled trial.