Thorac Cardiovasc Surg 2004; 52
DOI: 10.1055/s-2004-816809

Standard or mini-CPB? Impact on organ perfusion

A Liebold 1, C Wiesenack 2, C Prasser 2, A Philipp 1, M Jagiello 1, DE Birnbaum 1
  • 1Klinik f�r Herz-, Thorax- und herznahe Gef��chirurgie
  • 2Klinik f�r An�sthesiologie und Intensivmedizin, Klinikum der Universit�t Regensburg, Germany

Objectives: Few data exist on organ perfusion during mini-CPB procedures. We prospectively studied liver and brain perfusion in CABG surgery performed either in standard CPB or mini-CPB (minimized extracorporeal circulation, MECC) technique.

Material and Methods: The MECC System (JOSTRA, Germany) is a closed, heparin coated mini-CPB containing a centrifugal pump and a low resistance membrane oxygenator as the only components. Forty patients were randomised to receive either standard CPB (n=19) or MECC (n=21). In both groups low volume blood cardioplegia was used. Hemodynamics and liver perfusion were measured using the COLD system (Pulsion, Germany). Plasma disappearance rate (PDR) and blood clearance (CB) of indocyanine green were calculated baseline and up to 6h postoperatively. Cerebral perfusion was indirectly estimated by changes of the cerebral oxygen saturation (cSO2) using the INVOS system (Somanetics, Troy. MI, U. S).

Results: Preoperative variables, number of anastomoses, CPB and X-clamp time, enzyme levels, inotropic support, bleeding, ventilation, ICU and hospital stay were comparable between the groups. Both PDR and CB showed significant increase from baseline to postoperative values with no differences found between the groups. MECC patients showed higher perfusion pressures which was reflected by increased cSO2 values. Postoperative cardiac output tended to be higher in the MECC group with equal doses of catecholamines.

Parameter

CPB

MECC

p value

CPB (min)

71±13

73±9

0.660

X-clamp (min)

42±6

48±7

0.090

Hemoglobin min (g/dl)

7.6±1

10.5±1

0.010

CO (l/min)

5.9±1

7.8±1

0.003

CB max (l/min)

1.56±0.4

1.97±0.6

0.180

PDR max (%/min)

23.8±4

22.2±6

0.320

CPB Flow (l/min)

5.1±0

3.8±0

0.001

MAP (mmHg)

53±1

71±1

0.010

cSO2 max (%)

89±1

100±1

0.010

Conclusions: Mini-CPB proved to be sufficient in hepatic and cerebral perfusion. Advantages over the standard CPB may arise from the MECC design, which allows perfusion with a constant volume of less diluted blood.