Combined coronary artery bypass grafting and aortic valve replacement with minimal extracorporeal closed circuit circulation versus standard cardiopulmonary bypass.

Isolated aortic valve replacement (AVR) or coronary artery bypass grafting (CABG) using minimized extracorporeal circulation (MECC) has been shown to have less deleterious effects than standard cardiopulmonary bypass (CPB). In this prospective cohort study, we evaluated and compared clinical results of combined AVR with CABG using MECC. We prospectively collected preoperative, intraoperative, postoperative and follow-up data of 65 patients who underwent combined AVR with CABG using MECC and compared these with 135 patients undergoing combined AVR with CABG using standard CPB. No significant differences were seen in patients demographic characteristics or intraoperative data. Patients in the MECC group experienced a smaller preoperative haemoglobin drop (4.5±0.8 g/dl vs. 5.0±0.5 g/dl, P=0.002) resulting in higher haemoglobin at discharge (11.3±1.3 g/dl vs. 10.8±1.1 g/dl, P=0.03). They had decreased blood products requirements (P=0.004) compared to patients in the standard CPB group. No differences were noted in pulmonary complications, neurological events or mortality. We present for the first time data showing that combined AVR with CABG using MECC is feasible and provides better clinical results compared to standard CPB with regard to blood products requirements, without compromising operative morbidity or mortality.

Minimal access aortic valve replacement using a minimal extracorporeal circulatory system.

BACKGROUND: Minimal access aortic valve replacement (mAVR) has been demonstrated to be beneficial over standard median sternotomy. Similarly, minimal extracorporeal circulation (MECC) has been shown to have less deleterious effects than conventional cardiopulmonary bypass. We report a previously undescribed technique for AVR in combination with MECC by minimal access. METHODS: We prospectively collected data including one-month postoperative follow-up of the first 50 patients who underwent mAVR utilizing MECC. A temporary Cordis Ventricor (Cordis Corp, Miami, FL) ventricular pacemaker and external defibrillation pads were placed at induction. A J-shaped partial upper sternotomy ending in the third intercostal space was performed. Cannulation was performed in the groin using the Seldinger technique. A vent was introduced directly in the pulmonary artery. Warm blood cardioplegia and carbon dioxide field flooding were used. RESULTS: Fifty consecutive patients (24 male) with a mean age of 68 (range, 34 to 89) were operated between May and December 2007. Operating time was 147 +/- 20 minutes, cross-clamp time was 64 +/- 10 minutes, and perfusion time was 84 +/- 17 minutes. There were no conversions to median sternotomy. Only one peroperative blood transfusion was required and postoperative blood loss was 372 +/- 170 cc. Intensive care unit stay was uneventful (average stay 2 days, range 1 to 8). One patient required a permanent pacemaker and other complications included pneumothorax, superficial wound infection, a late transient postoperative neurologic deficit, and excessive postoperative blood loss requiring mediastinal reexploration. Renal failure and major cerebral accidents did not occur. There was a 100% survival at one-month follow-up. CONCLUSION: We have shown that minimal access aortic valve replacement using minimal extracorporeal circulation is feasible and provides excellent clinical and cosmetic results.