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OBJECTIVE: Mini-circuit cardiopulmonary bypass (CPB) would induce less inflammation and blood trauma by limiting the blood-air interaction and decreasing surface area of artificial materials. Off-pump CABG is also considered minimally invasive because it avoids risk of using CPB. In this study, we evaluated clinical outcomes, myocardial and pulmonary injury with mini-circuit CPB comparing to conventional CPB and off-pump CABG.
METHODS: Consecutive 88 solo CABG, which the same surgeons performed in the recent four years in single hospital were enrolled. We retrospectively obtained WBC count, creatinine kinase (CK), myocardial band (CK-MB), CRP, PaO2/Fio2 ratio, perioperative bleeding as well as clinical course and compared between conventional CPB (Group C:34 cases), mini-circuit CPB (Group M:28 cases) and off pump CABG (Group O:26 cases).
RESULTS: There were no significant differences in patients’ age and sex between the groups. The number of distal anastomosis was fewer in group O (group C; 3.2±0.8, M; 3.4±0.6, O; 2.7±0.7, p<0.0.1) No mortality was observed in all groups. Operation time in group O was shorter than group C and M but hospitalization time was not different between groups. Intubation period and drainage period in group O was longer than group C and M. Bleeding during surgery and post-operative bleeding in Group O was more common than group C and M (p=0.01, p=0.02, respectively). The maximum CK and CK-MB after the surgery did not differ between the groups. The maximum CRP after the surgery was higher in group O than the other two groups (p<0.01) although WBC count was lower than the two groups (p=0.01). PaO2/Fio2 ratio as respiratory function was better in Group M compared to group O (316±107 vs 261±97, P=0.04), although no significant difference were found between group C and M. Platelet count was decreasing postoperatively in all groups, but reduction rate; (preOP Plt-post OP Plt)/preOP Plt was larger in group O (C; 30±12%, M; 25±18%, O; 39±16%, p=0.03) than in the other groups.
CONCLUSIONS: Mini-circuit showed less pulmonary injury and platelet damage. Off-pump had more bleeding than mini-circuit and conventional CPB. Inflammation was controversial between off-pump and CPB groups. Mini-circuit might be minimally invasive for CABG.