Published Online
on September 17, 2007

A more recent version of this article appeared on October 16, 2007

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Submitted on February 26, 2007
Accepted on August 8, 2007

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, and 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.

^* To whom correspondence should be addressed. E-mail: gnasso{at}libero.it.

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.

Key words: surgery • coronary disease • grafting • cardiopulmonary bypass • complications

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