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document
Comparing microvascular alterations during minimal extracorporeal circulation and conventional cardiopulmonary bypass in coronary artery bypass graft surgery : a prospective , randomized study . OBJECTIVES Minimal extracorporeal circulation ( MECC ) has been introduced in coronary artery bypass graft ( CABG ) surgery , offering clinical benefits owing to reduced hemodilution and no blood-air interface . Yet , the effects of MECC on the intraoperative microvascular perfusion in comparison with conventional extracorporeal circulation ( CECC ) have not been studied so far . METHODS The current study aimed to analyze alterations in microvascular perfusion at 4 predefined time points ( T1-T4 ) during on-pump CABG using orthogonal polarization spectral imaging . Forty patients were randomized for being operated on with either MECC or CECC . Changes in functional capillary density ( FCD ) , blood flow velocity , and vessel diameter were analyzed by a blinded investigator . RESULTS After start of extracorporeal circulation ( ECC ) and aortic crossclamping ( T2 ) , both groups showed a significant drop of FCD , with a significantly higher FCD in the MECC group ( 206.8 ± 33.6 cm/cm² in CECC group versus 217.8 ± 35.3 cm/cm² in MECC group ; P = .034 ) . In the late phase of the ECC ( T3 ) , FCD in the MECC group was already recovered , whereas FCD in the CECC group was still significantly depressed ( 223.1 ± 35.6 cm/cm² in MECC group ; P = .100 vs T1 ; 211.1 ± 36.9 cm/cm² in CECC group ; P = .017 vs T1 ) . After termination of ECC ( T4 ) , FCD recovered in both groups to baseline . Blood flow velocity tended to be higher in the MECC group , with a significant intergroup difference after aortic crossclamping ( T2 ) . CONCLUSIONS Orthogonal polarization spectral imaging data reveal an impairment of microvascular perfusion during on-pump CABG . Changes in FCD indicate a faster recovery of the microvascular perfusion in MECC during the reperfusion period . Beneficial recovery of microvascular organ perfusion could partly explain the perioperative advantages reported for MECC .
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Intervention_Surgical
extracorporeal circulation
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Intervention_Surgical
cardiopulmonary bypass
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Intervention_Surgical
coronary artery bypass graft surgery
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Intervention_Physical
Minimal extracorporeal circulation ( MECC )
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Intervention_Surgical
coronary artery bypass graft ( CABG ) surgery
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Intervention_Surgical
MECC
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Intervention_Physical
conventional extracorporeal circulation ( CECC )
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Intervention_Surgical
MECC
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Intervention_Surgical
CECC
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Outcome_Physical
microvascular alterations
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Outcome_Physical
alterations in microvascular perfusion
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Outcome_Physical
functional capillary density ( FCD )
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Outcome_Physical
blood flow velocity
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Outcome_Physical
vessel diameter
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Outcome_Physical
FCD
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Outcome_Physical
FCD
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Participant_Condition
coronary artery bypass
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Participant_Sample-size
Forty