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Service de Chirurgie Cardiaque, Amiens Hôpital Sud, Rue Laennec, Amiens Cedex 1, 80054 France
(Email: jprema{at}voila.fr).
The first mini-cardiopulmonary bypass (CPB) with the minimal extracorporeal circulation system (Jostra MECC System; Jostra AG, Hirrlingen, Germany) performed in our institution was in 2001 [1]. Initially, we performed only coronary artery bypass grafting (CABG) with a system that was totally closed, without a vent. The left ventricle was not always vented. In 2002, therefore, a suction system was added to the MECC circuit. With this system, two suction devices can be used simultaneously. This addition should be considered a "semi-closed" system because a vent may also be implanted in the ascending aorta for CABG procedures or in the pulmonary artery for aortic valve replacement (AVR). A venous filter was added to avoid the risk of air embolism. We now perform CABG and AVR with this system. We do not perform right heart or redo procedures with the MECC system.
Mini-CPB is associated with less deleterious clinical and biologic effects and better blood preservation. It also provides surgical exposure that is comparable to standard CPB and superior to off-pump CABG (OPCABG).
In a recent article [2], mini-CPB was recommended to achieve OPCABG benefits of less morbidity in high-risk patients while facilitating complete revascularization for complex lesions unsuitable for OPCABG. Like the authors, we find that a learning curve is necessary for all teams but is not associated with higher operative risk, even for first procedures.
We have performed about 1500 MECC procedures without any systemic injury or serious instances of arterial air embolism. The risk of hypoperfusion with this system, described by the authors [3], can be avoided by intraoperative arterial pressure monitoring and optimal patient fluid volume to sustain satisfactory centrifugal pump function.
The anticoagulation protocol remains very important. It has been suggested that the heparin dose may be reduced within a fully preheparinized closed-loop CPB system with activated clotting times of 250 seconds for CABG and 350 seconds for AVR [4]. Thus, the protamine dose and deleterious heparin-protamine complex could be reduced. In this way, an optimal anticoagulation protocol may improve postoperative results of the use of the mini-CPB system.
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  M. P. Sakwa, R. W. Emery, F. L. Shannon, J. M. Altshuler, D. Mitchell, D. Zwada, and A. R. Holter Coronary artery bypass grafting with a minimized cardiopulmonary bypass circuit: a prospective, randomized trial. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 481 - 485. [Abstract] [Full Text] [PDF]
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