Minimally invasive extracorporeal circulation is a cost-effective alternative to conventional extracorporeal circulation for coronary artery bypass grafting: propensity matched analysis.

INTRODUCTION: Minimally invasive extracorporeal circulation has developed with the aim of reducing the impact of the adverse effects associated with conventional extracorporeal circulation. The aim of this study was to compare outcomes for patients undergoing coronary artery bypass grafting using minimally invasive extracorporeal circulation with those performed using conventional extracorporeal circulation. METHODS: A retrospective analysis was performed of patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting at a single centre. 2:1 propensity matching was performed to identify control patients undergoing conventional extracorporeal circulation coronary artery bypass grafting. Outcomes were compared using univariate analysis. RESULTS: A total of 354 patients were included in the study, with 118 patients undergoing minimally invasive extracorporeal circulation coronary artery bypass grafting. Patients were well matched on baseline characteristics. The mean logistic EuroSCORE was 3.95 ± 4.20. Operative times (3.31 ± 1.52 vs. 3.56 ± 0.73, p = 0.03) were significantly shorter in minimally invasive extracorporeal circulation cases. Patients who underwent surgery with minimally invasive extracorporeal circulation had significantly less 12-hour blood loss (322.3 ± 13.2 mL vs. 380.8 ± 15.2 mL, p < 0.01). Correspondingly, a significantly lower proportion of patients were transfused (25.8% vs. 36%, p = 0.04), and the mean number of red blood cells transfused was lower (0.45 ± 0.95 vs. 0.97 ± 2.13, p = 0.01). Similarly, the number of coagulation products administered was lower (0.161 ± 0.05 vs. 0.40 ± 0.09, p = 0.05). There was a significantly lower incidence of acute kidney injury (11.0% vs. 19.9%, p = 0.03). Minimally invasive extracorporeal circulation was associated with a £679.50 cost saving per patient. DISCUSSION: Minimally invasive extracorporeal circulation for coronary artery bypass grafting is associated with a reduced requirement for blood transfusion, reduced incidence of acute kidney injury and a significant cost saving. Minimally invasive extracorporeal circulation should be considered as an adjunct for all patients undergoing coronary artery bypass grafting.

The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study.

OBJECTIVES: To investigate the association between pulsatile perfusion and cardiac surgery-associated acute kidney injury. DESIGN: An uncontrolled, retrospective before-and-after study. SETTING: Single tertiary hospital. PARTICIPANTS: A total of 2,489 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: Pulsatile versus nonpulsatile perfusion. MEASUREMENTS AND MAIN RESULTS: Data for nonpulsatile perfusion was collected from April 1, 2016, to March 31, 2017 (n = 1,223). A practice change to universal pulsatile CPB occurred on April 3, 2017. Data for pulsatile perfusion was collected from May 1, 2017, to June 30, 2018 (n = 1,266). The primary outcome was the incidence of acute kidney injury (AKI) after cardiac surgery. Multivariable analysis was carried out to adjust for known confounders. Secondary outcomes included AKI stage, stroke, length of stay, and mortality. Subgroup analyses were carried out using prolonged CPB and chronic kidney disease. The primary outcome, incidence of AKI, did not differ between the nonpulsatile control group and the pulsatile group (23.9% v 25.4%, p = 0.392). The pulsatile group was not associated with AKI in the multivariable analysis (Odds ratio 1.09, p = 0.413). There were no differences in stages of AKI in the nonpulsatile group v pulsatile group (13.6% v 14.9%, 2.9% v 4.3%, and 7.4% v 6.1% for stages 1, 2, and 3, respectively, p = 0.12). There were no differences in subgroup analyses or secondary outcomes. CONCLUSIONS: There was no association found between kidney injury and pulsatile perfusion. It is likely that there is either no association between pulsatile perfusion and reduced kidney injury or that the difference is extremely small.