Complete revascularization of patients with severe left ventricular dysfunction using mini extracorporeal circulation

Background and aim Mini extracorporeal circulation (MECC) when used as on-pump beating cardiac support during coronary artery bypass grafting can be a better alternative than the conventional cardiopulmonary bypass with aortic cross-clamping and cardioplegic arrest [(conventional cardiopulmonary bypass (cCPB)] in complete revascularization of patients with ejection fraction (EF) <30%. Patients and methods A retrospective study was conducted on consecutive 50 patients with chronic stable severely impaired EF (< 30%) who underwent isolated coronary artery bypass grafting surgery using MECC from January 2011 to June 2016 (group I), and they were compared with another 50 matched patients randomized to similar group connected to cCPB from January 2009 to June 2014 (group II). Emergency, unstable, combined surgery and end-stage renal disease patients on dialysis are excluded. Results There was no difference in CPB time, perioperative myocardial infarction (MI) or mortality between the two groups. Defibrillation was required in 10% in group I and in 82% in group II, with significantly lower cumulative energy of defibrillation (joules) (P<0.001). In group I, the requirement of inotropic support, incidence of atrial fibrillation (AF), the need for mechanical support, postoperative bleeding, the mean haematocrit value and the need for allogenic blood and products transfusion were significantly lower than in the group II (P<0.001), but the incidence of re-exploration was overall low (4% in group I) vs. 12% in group II), with a trend towards being significant (P=0.058). Postoperative creatine kinase MB isoenzyme and cardiac troponin I were significantly lower in group I (P<0.05) for 48 h. Lower postoperative creatinine (<0.01) was seen in group I. Duration of ventilation and length of ICU stay showed a trend towards being significant (P=0.053 and 0.057), but the total hospitalization time was significantly shorter in group I (P<0.05). Conclusion On-pump beating heart revascularization of low EF patients using MECC is a safe procedure with better outcome than cCPB in low EF patients. It is followed by a diminished release of ischaemia markers, better early and smooth postoperative course and lower total hospitalization time than after cCPB, and both result in a satisfactory clinical outcome.