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Publication:

Surgical Technology International XVI - Cardiovascular Surgery

Article title:

Compact Extracorporeal Circulation: Reducing the Surface of Cardiopulmonary Bypass to Improve Outcomes

Author(s)

Umberto Borrelli, C.C.P.
Chief of the Department of Perfusion
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Nawwar Al-Attar, F.R.C.S., F.E.T.C.S., M.Sc.
Cardiac Surgeon
Department of Cardiac Surgery, Hopital Bichat, Paris, France

 

Marc Detroux, M.D.
Cardiac Surgeon
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Remi Nottin, M.D.
Cardiac Surgeon
Department of Cardiac Surgery, Hospital Marie Lannelongue, Paris, France

 

Stéphane Nikis, M.D.
Anesthetist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Serge Jennes, M.D.
Anesthetist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Pierre Nackers, M.D.
Anesthetist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Geert Baert, M.D.
Anesthetist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

Benoit Colinet, M.D.
Anesthetist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Christian Miesse, M.D.
Intensive Care Physician
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

Jaroslaw Fijakowski, C.C.P.
Clinical Perfusion Scientist
Department of Cardiovascular Surgery, St-Joseph Hospital, Gilly, Belgium

 

François Perron
Chief, Department of Perfusion
Hospital St-Paul, Vancouver, Canada

Abstract

We have introduced a number of modifications to minimize the deleterious effects of cardiopulmonary bypass (CPB) by reducing the surface of the extracorporeal circulation (ECC), the length of the ECC circuit, the contact surface of the oxygenator, and the volume of priming solution, in addition to employing biocompatible systems and isolation of excess blood volumes of venous reservoirs in transfusion bags very early in CPB. Encouraged by the results of our initial "Compact ECC," we have decided to improve it by implementing other techniques such as controlled hemodilution of the patient by reducing the diameter of ECC venous tubing (from 1/2 in. to 3/8 in.), limiting contact surface of the oxygenator and venous reservoir, positioning the oxygenator and venous reservoir at the level of the patient's shoulder, and employing venous cannulae adapted to vacuum assisted venous drainage (VAVD) to replace venous drainage by gravity. The purpose of this study is to evaluate postoperative outcomes of Compact ECC. Three groups of patients undergoing coronary artery bypass graft (CABG) are compared. Our new Compact ECC shows improved outcomes through reduced postoperative ventilation time, blood loss, intensive care stay, need for blood transfusion, and levels of lactate dehydrogenase despite the patients' pathologies and surgeries being more complex.