This Article Full Text Full Text (PDF) All Versions of this Article: 116/16/1761    most recent CIRCULATIONAHA.107.697482v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mazzei, V. Articles by Anselmi, A. Search for Related Content PubMed PubMed Citation Articles by Mazzei, V. Articles by Anselmi, A. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Coronary Artery Bypass Surgery Coronary Artery Disease Related Collections CV surgery: coronary artery disease Related Article

(Circulation. 2007;116:1761-1767.)
© 2007 American Heart Association, Inc.

Cardiovascular Surgery

Prospective Randomized Comparison of Coronary Bypass Grafting With Minimal Extracorporeal Circulation System (MECC) Versus Off-Pump Coronary Surgery

Valerio Mazzei, MD; Giuseppe Nasso, MD; Giovanni Salamone, MD; Filippo Castorino, MD; Antonello Tommasini, MD; Amedeo Anselmi, MD

From the Division of Cardiac Surgery, Ospedale Papardo (V.M., G.S., F.C., A.T.), Messina, Italy, and the Division of Cardiac Surgery, Catholic University (G.N., A.A.), Rome, Italy.

Correspondence to Giuseppe Nasso, MD, Division of Cardiac Surgery, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy. E-mail gnasso{at}libero.it

Received February 26, 2007; accepted August 8, 2007.

Background— We aimed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system (MECC) compared with off-pump coronary revascularization (OPCABG).

Methods and Results— In a prospective randomized study, 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG. End points were (1) circulating markers of inflammation and organ injury, (2) operative results, and (3) outcome at 1-year follow-up. Operative mortality and morbidity were comparable between the groups. Release of inflammatory markers was similar between groups at all time points (peak interleukin-6 167.2±13.5 versus 181±6.5 pg/mL, P=0.14, OPCABG versus MECC group, respectively). Peak creatine kinase was 419.3±103.5 versus 326±84.2 mg/dL (P=0.28), and peak S-100 protein was 0.13±0.08 versus 0.29±0.1 pg/mL (P=0.058, OPCABG versus MECC group, respectively). Length of hospital stay and use of blood products were similar between groups. Two cases of angina recurrence at 1 year in the MECC group were observed versus 5 cases observed in the OPCABG group (P=0.44). A residual perfusion defect at myocardial nuclear scan was less frequent among patients in the MECC group (3 versus 9 cases, P=0.14; odds ratio 0.32, 95% confidence interval 0.07 to 1.32). Six (OPCABG group) versus 3 (MECC group) coronary grafts were occluded or severely stenotic at 1 year (P=0.33, odds ratio 0.47, 95% confidence interval 0.09 to 2.14).

Conclusions— Clinical results of coronary revascularization with MECC are optimal when this procedure is performed by experienced teams. Postoperative morbidity is comparable to that with OPCABG. MECC is associated with little pump-related systemic and organ injury. It may achieve the benefits of OPCABG (less morbidity in high-risk patients) while facilitating complete revascularization in the case of complex lesions unsuitable for OPCABG.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2007 116: 1755. [Full Text]

This article has been cited by other articles:

				J.-P. Remadi Invited Commentary Ann. Thorac. Surg., March 1, 2008; 85(3): 1000 - 1001. [Full Text] [PDF]

				A New Alternative to Off-Pump Coronary Artery Bypass Grafting? Journal Watch Cardiology, November 14, 2007; 2007(1114): 4 - 4. [Full Text]

				J. D. Puskas and M. Steele Would You Like Some Cardiopulmonary Bypass With Your Coronary Revascularization? Circulation, October 16, 2007; 116(16): 1756 - 1758. [Full Text] [PDF]