Miniaturized Extracorporeal Circuits: Innovative Approaches in Cardiac Surgery

Gülşah Çelik Korhan

doi:10.5281/zenodo.19238574

Yazarlar

Gülşah Çelik Korhan Harran Üniversitesi

DOI:

https://doi.org/10.5281/zenodo.19238574

Anahtar Kelimeler:

Minimal invaziv ekstrakorporeal dolaşım, Kardiyopulmoner bypass, Perfüzyon teknolojisi, Organ koruması, Kardiyak cerrahi

Özet

Minimal İnvaziv Ekstrakorporeal Dolaşım (MiECC) sistemleri, konvansiyonel kardiyopulmoner bypass ile ilişkili hemodinamik bozuklukları, sistemik inflamatuar yanıtı ve perioperatif komplikasyonları azaltmak amacıyla geliştirilmiş ileri düzey perfüzyon teknolojileridir. Kapalı devre, heparin kaplı ve miniatürize tasarıma sahip olan MiECC, venöz rezervuar içermez, priming hacmini minimize eder ve kanın yapay yüzeylerle temasını azaltarak sistemik inflamatuar yanıtın kontrolünü sağlar. Ayrıca, optimize edilmiş devre tasarımı perioperatif hematokrit seviyelerinin korunmasına, oksijen taşıma kapasitesinin sürdürülmesine ve transfüzyon gereksiniminin azalmasına katkıda bulunur.

MiECC’de kullanılan teknik iyileştirmeler arasında yalnızca kanla temas halinde aktive olan aspirasyon sistemleri, postoperatif ototransfüzyon için hücresel kan geri kazanım (cell saver) sistemleri ve modüler devre tasarımları öne çıkar. Klinik çalışmalar ve meta-analizler, MiECC kullanımının postoperatif morbiditeyi azalttığını, böbrek ve miyokard fonksiyonunu koruduğunu ve inflamatuar belirteçlerde düşüş sağladığını göstermektedir. Kapalı devre ve düşük priming hacmi sayesinde heparin ihtiyacı azalmakta, kanama riski minimize edilmekte ve hasta güvenliği artmaktadır. Bu derlemede, MiECC sistemlerinin teknik özellikleri, uygulama yöntemleri ve klinik avantajları güncel araştırma bulguları ışığında ayrıntılı şekilde ele alınmış, kardiyak cerrahideki potansiyel rolü ve faydaları vurgulanmıştır.

Referanslar

D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Ann Thorac Surg. 2018; 105:15-23.

Khan NE, De Souza A, Mister R, Shroyer AL, Collins JF, Hattler B, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004;350(1):21–28.

Anastasiadis K, Murkin J, Antonitsis P, Bauer A, Ranucci M, Gygax E, et al. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS). Interact Cardiovasc Thorac Surg. 2016;22(5):647-662.

Brian BF. The engineering of cardiopulmonary bypass. In: Mongero LB, Beck JR, editors. On Bypass: Advanced Perfusion Techniques. Totowa, NJ: Humana Press; 2008. p. 1–28.

Anastasiadis K, Antonitsis P, Argiriadou H, Deliopoulos A, Grosomanidis V, Tossios P, et al. Modular minimally invasive extracorporeal circulation systems: can they become the standard practice for performing cardiac surgery? Perfusion. 2015;30(3):195–200.

Formica F, Mariani S, Broccolo F, Caruso R, Corti F, D'Alessandro S, et al. Systemic and myocardial inflammatory response in coronary artery bypass graft surgery with miniaturized extracorporeal circulation: differences with a standard circuit and off-pump technique in a randomized clinical trial. ASAIO J. 2013;59(6):600–606.

Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. From less invasive to minimal invasive extracorporeal circulation. J Thorac Dis. 2021;13(3):1909–1921.

Jenni H, Heinisch PP, Eberle B, Gisler F, Kadner A, Carrel T, et al. From minimal invasive extracorporeal circulation type I to type III: the perfusionist's view. J Thorac Dis. 2019;11(Suppl 10): S1515–S1518.

Stalder M, Gygax E, Immer FF, Englberger L, Tevaearai H, Carrel TP, et al. Minimized cardiopulmonary bypass combined with a smart suction device: the future of cardiopulmonary bypass? Heart Surg Forum. 2007;10(3): E235–E238.

Kowalewski M, Pawliszak W, Raffa GM, Malvindi PG, Anisimowicz L, Kowalkowska ME, et al. Safety and efficacy of miniaturized extracorporeal circulation when compared with off-pump and conventional coronary artery bypass grafting: evidence synthesis from a comprehensive Bayesian-framework network meta-analysis of 134 randomized controlled trials involving 22 778 patients. Eur J Cardiothorac Surg. 2016;49(5):1428-1440. doi:10.1093/ejcts/ezv387.

Karamlou T, Schultz JM, Silliman C, Sandquist C, You J, Shen I, et al. Using a miniaturized circuit and an asanguineous prime to reduce neutrophil-mediated organ dysfunction following infant cardiopulmonary bypass. Ann Thorac Surg. 2005;80(1):6–13.

Comparison of platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems. Anatolian Journal of Cardiovascular Surgery (AZJCVS). 2024;5(1):13–17. doi:10.5455/azjcvs.2024.03.06.

Liu Y, Tao L, Wang X, Cui H, Chen X, Ji B, et al. Beneficial effects of using a minimal extracorporeal circulation system during coronary artery bypass grafting. Perfusion. 2012;27(1):83–89.

Farag M, Patil NP, Sabashnikov A, Arif R, Szabó G, Kallenbach K, et al. Comparison of two miniaturized cardiopulmonary bypass systems regarding inflammatory response. Artif Organs. 2017;41(2):139–145.

Liebold A, Albrecht G. Minimized extracorporeal circulation in non-coronary surgery. J Thorac Dis. 2019;11(Suppl 10):S1498–S1506.

Zajonz T, Koch C, Schwiddessen J, Markmann M, Hecker M, Edinger F, et al. Minimized extracorporeal circulation is associated with reduced plasma levels of free-circulating mitochondrial DNA compared to conventional cardiopulmonary bypass: a secondary analysis of an exploratory, prospective, interventional study. J Clin Med. 2022;11(11):2994.

Apostolakis EE, Koletsis EN, Baikoussis NG, Siminelakis SN, Papadopoulos GS. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. J Cardiothorac Surg. 2010;5:1.

Bennett MJ, Rajakaruna C, Bazerbashi S, Webb G, Gomez-Cano M, Lloyd C, et al. Oxygen delivery during cardiopulmonary bypass and renal outcome using two systems of extracorporeal circulation: a retrospective review. Interact Cardiovasc Thorac Surg. 2013;16(6):760–764.

Yuruk K, Bezemer R, Euser M, Milstein DMJ, de Geus HHR, Scholten EW, et al. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery. Interact Cardiovasc Thorac Surg. 2012;15(3):364–370.

Karamlou T, Hickey E, Silliman CC, Shen I, Ungerleider RM. Reducing risk in infant cardiopulmonary bypass: the use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2005;8:3–11.

Bennett MJ, Weatherall M, Webb G, Dudnikov SF, Lloyd CT, et al. The impact of haemodilution and bypass pump flow on cerebral oxygen desaturation during cardiopulmonary bypass: a comparison of two systems of cardiopulmonary bypass. Perfusion. 2015;30(5):389–394.

Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Prospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J. 2006;151(1):198. doi:10.1016/j.ahj.2005.03.067.

Basciani R, Kröninger F, Gygax E, Jenni H, Reineke D, Stucki M, et al. Cerebral microembolization during aortic valve replacement using minimally invasive or conventional extracorporeal circulation: a randomized trial. Artif Organs. 2016;40(12): E280–E291.

Bhirowo YP, Raksawardana YK, Setianto BY, Sudadi S, Tandean TN, Zaharo AF, et al. Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors. J Cardiothorac Surg. 2023;18(1):291.

John A, Bennett M, Lloyd C, Allen S. Overcoming challenges: the use of minimal extracorporeal circulation in Jehovah’s Witnesses undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2010;139(6): e122–e123.

Vohra HA, Whistance R, Modi A, Ohri SK. The inflammatory response to miniaturised extracorporeal circulation: a review of the literature. Mediators Inflamm. 2009; 2009:707042.

Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 2003;75(2): S715–S720.

Halle DR, Benhassen LL, Søberg KL, Nielsen PF, Kimose HH, Bauer A, et al. Impact of minimal invasive extracorporeal circulation on systemic inflammatory response: a randomized trial. J Cardiothorac Surg. 2024; 19:418.

Rufa M, Schubel J, Ulrich C, Schaarschmidt J, Tiliscan C, Bauer A, et al. A retrospective comparative study of minimally invasive extracorporeal circulation versus conventional extracorporeal circulation in emergency coronary artery bypass surgery patients: a single surgeon analysis. Interact Cardiovasc Thorac Surg. 2015;21(1):102–107.

Puehler T, Haneya A, Philipp A, Zausig YA, Kobuch R, Diez C, et al. Minimized extracorporeal circulation system in coronary artery bypass surgery: a 10-year single-center experience with 2243 patients. Eur J Cardiothorac Surg. 2011;39(4):459–464.

Puehler T, Haneya A, Philipp A, Camboni D, Hirt S, Zink W, et al. Minimized extracorporeal circulation in coronary artery bypass surgery is equivalent to standard extracorporeal circulation in patients with reduced left ventricular function. Thorac Cardiovasc Surg. 2010;58(4):204–209.

Mueller XM, Jegger D, Augstburger M, Horisberger J, Godar G, von Segesser LK. A new concept of integrated cardiopulmonary bypass circuit. Eur J Cardiothorac Surg. 2002;21(5):840–846.

Colli A, Fernandez C, Delgado L, Romero B, Camara ML, Ruyra X. Aortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass. Interact Cardiovasc Thorac Surg. 2009;9(4):583–587.

Fromes Y, Gaillard D, Ponzio O, Chauffert M, Gerhardt MF, Deleuze P, et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002;22(4):527–533.

El-Essawi A, Hajek T, Skorpil J, Böning A, Sabol F, Hausmann H, et al. A prospective randomized multicentre clinical comparison of a minimized perfusion circuit versus conventional cardiopulmonary bypass. Eur J Cardiothorac Surg. 2010;38(1):91–97.

Ohata T, Mitsuno M, Yamamura M, Tanaka H, Kobayashi Y, Ryomoto M, et al. Beneficial effects of mini-cardiopulmonary bypass on hemostasis in coronary artery bypass grafting: analysis of inflammatory response and hemodilution. ASAIO J. 2008;54(2):207–209.

Momin AU, Sharabiani MT, Kidher E, Prabhu S, Kharbanda RK, Anderson JR, et al. Feasibility and safety of minimized cardiopulmonary bypass in major aortic surgery. Interact Cardiovasc Thorac Surg. 2013;17(4):659–663.

Anastasiadis K, Argiriadou H, Deliopoulos A, Antonitsis P. Minimal invasive extracorporeal circulation (MIECC): the state-of-the-art in perfusion. J Thorac Dis. 2019;11(Suppl 10): S1507–S1514.

Condello I, Speziale G, Nasso G. Develop of endocavitary suction device for MIECC on minimally invasive mitral valve surgery. J Cardiothorac Surg. 2024;19(1):157.

Koechlin L, Gahl B, Miazza J, Zenklusen U, Rahmani B, Vasiloi I, et al. Minimal extracorporeal circulation and microplegia in the setting of urgent coronary artery bypass grafting. J Clin Med. 2022;11(24):7488.