Skip to main content
SpringerLink
Log in

MECC—The Perfusionist’s Point of View. One Decade MECC: From a Pioneering to Standard Procedure

  • Chapter
  • First Online:
Principles of Miniaturized ExtraCorporeal Circulation

  • 874 Accesses

Abstract

Currently, cardiac surgery offers four options to treat coronary artery disease (CAD): conventional extracorporeal circulation (CECC), minimised extracorporeal circulation (MECC), pump-assisted beating heart (PACAB) and off-pump coronary artery bypass (OPCAB). Coronary artery bypass grafting using CECC is still the most accepted and applied technique for the surgical treatment of CAD today. It is a safe and well-established technique with a low mortality rate [1–3]. Although morbidity caused by CECC is still significant [4, 5], the vast majority of CABG procedures using CECC are without any complications. Nevertheless, 35 % of all perioperative complications are reported to be related to the use of the heart–lung machine [6].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Immer FF, Pirovino C, Gygax E, Englberger L, Tevaearai H, Carrel TP (2005) Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg 28:701–704

    Article  PubMed  Google Scholar 

  2. Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL (1998) Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:1273–1277

    Article  PubMed  CAS  Google Scholar 

  3. Cheng W, Denton TA, Fontana GP, Raissi S, Blanche C, Kass RM, Magliato KE, Mirocha J, Trento A (2002) Off-pump coronary surgery: effect on early mortality and stroke. J Thorac Cardiovasc Surg 124:313–320

    Article  PubMed  Google Scholar 

  4. Chang PP, Sussman MS, Conte JV, Grega MA, Schulman SP, Gerstenblith G, Wang NY, Capriotti A, Weiss JL (2002) Postoperative ventricular function and cardiac enzymes after on-pump versus off-pump CABG surgery. Am J Cardiol 89:1107–1110

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Borst C, Grundeman PF (1999) Minimally invasive coronary artery bypass grafting: an experimental ­perspective. Circulation 99:1400–1403

    Article  PubMed  CAS  Google Scholar 

  7. Boettcher W, Merkle F, Weitkemper HH (2003) History of extracorporeal circulation: the conceptional and developmental period. J Extra Corpor Technol 35:172–183

    PubMed  Google Scholar 

  8. Zalaquett R (2003) Fifty years of the heart-lung machine. Report on the pioneers and heroes and about the circumstances that led to the great invention, which allowed the treatment, and in many cases, the cure of heart illnesses. Rev Med Chil 131:1337–1344

    PubMed  Google Scholar 

  9. Bjork VO, Sternlieb JJ, Davenport C (1985) From the spinning disc to the membrane oxygenator for open-heart surgery. Scand J Thorac Cardiovasc Surg 19:207–216

    Article  PubMed  CAS  Google Scholar 

  10. Johnston GG (1976) Prolonged pulsatile and nonpulsatile LV bypass with a centrifugal pump. Trans Am Soc Artif Intern Organs 22:323–331

    PubMed  CAS  Google Scholar 

  11. Stammers AH, Mejak BL, Rauch ED, Vang SN, Viessman TW (2000) Factors affecting perfusionists’ decisions on equipment utilization: results of a united states survey. J Extra Corpor Technol 32:4–10

    PubMed  CAS  Google Scholar 

  12. Palanzo DA, Zarro DL, Manley NJ, Montesano RM, Quinn M, Elmore BA, Gustafson PA, Castagna JM, Palanzo DA (2001) Effect of Carmeda BioActive Surface coating versus Trillium Biopassive Surface coating of the oxygenator on circulating platelet count drop during cardiopulmonary bypass. Perfusion 16:79–283

    Article  Google Scholar 

  13. Palanzo DA, Zarro DL, Manley NJ, Montesano RM, Quinn M, Gustafson PA (1999) Effect of surface coating on platelet count drop during cardiopulmonary bypass. Perfusion 14:195–200

    Article  PubMed  CAS  Google Scholar 

  14. Mottaghy K, Oedekoven B, Schaich-Lester D, Pöppel K, Küpper W (1989) Application of surfaces with end point attached heparin to extracorporeal circulation with membrane lungs. ASAIO Trans 35:146–152

    Article  PubMed  CAS  Google Scholar 

  15. Sáenz A, Larrañaga G, Alvarez L, Greco E, Marrero A, Lunar M, Elosegui C, Ubago JL, Gallo I (1996) Heparin-coated circuit in coronary surgery. A clinical study. Eur J Cardiothorac Surg 10:48–53

    Article  PubMed  Google Scholar 

  16. Blombäck M, Kronlund P, Aberg B, Fatah K, Hansson LO, Egberg N, Moor E, Carlsson K (1995) Pathologic fibrin formation and cold-induced clotting of membrane oxygenators during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 9:34–43

    Article  PubMed  Google Scholar 

  17. Yamada K (1978) Experimental and clinical investigation of closed circuit extracorporeal circulation for open heart surgery in infants. Nihon Geka Hokan 47:673–692

    PubMed  CAS  Google Scholar 

  18. Beholz S, Kessler M, Thölke R, Konertz W (2003) Priming reduced extracorporeal circulation setup (PRECiSe) with the DeltaStream diagonal pump. Artif Organs 27:1110–1115

    Article  PubMed  Google Scholar 

  19. Beholz S, Kessler M, Konertz WF (2005) A new PRECiSe (priming reduced extracorporeal circulation setup) minimizes the need for blood transfusions: first clinical results in coronary artery bypass grafting. Heart Surg Forum 8:E132–E135

    Article  PubMed  Google Scholar 

  20. Sato K, Namura O, Sogawa M, Shimada K, Tosaka Y, Hayashi J (2006) A reduced priming system. Artif Organs 30:635–638

    Article  PubMed  Google Scholar 

  21. Jönsson H, Nilsson A, Petersson F, Allers M, Laurell T (2005) Particle separation using ultrasound can be used with human shed mediastinal blood. Perfusion 20:39–43

    Article  PubMed  Google Scholar 

  22. Albes JM, Stöhr IM, Kaluza M, Siegemund A, Schmidt D, Vollandt R, Wahlers T (2003) Physiological coagulation can be maintained in extracorporeal circulation by means of shed blood separation and ­coating. J Thorac Cardiovasc Surg 126:1504–1512

    Article  PubMed  Google Scholar 

  23. Wippermann J, Albes JM, Hartrumpf M, Kaluza M, Vollandt R, Bruhin R, Wahlers T (2005) Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system. Eur J Cardiothorac Surg 28:127–132

    Article  PubMed  Google Scholar 

  24. Abdel-Rahman U, Ozaslan F, Risteski PS, Martens S, Moritz A, Al Daraghmeh A, Keller H, Wimmer-Greinecker G (2005) Initial experience with a minimized extracorporeal bypass system: is there a clinical benefit? Ann Thorac Surg 80:238–243

    Article  PubMed  Google Scholar 

  25. von Segesser LK, Tozzi P, Mallbiabrrena I, Jegger D, Horisberger J, Corno A (2003) Miniaturization in cardiopulmonary bypass. Perfusion 18:219–224

    Article  Google Scholar 

  26. Wiesenack C, Liebold A, Philipp A, Ritzka M, Koppenberg J, Birnbaum DE, Keyl C (2004) Four years’ experience with a miniaturized extracorporeal circulation system and its influence on clinical ­outcome. Artif Organs 28:1082–1088

    Article  PubMed  Google Scholar 

  27. Remadi JP, Marticho P, Butoi I, Rakotoarivelo Z, Trojette F, Benamar A, Beloucif S, Foure D, Poulain HJ (2004) Clinical experience with the mini-­extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg 77:2172–2175

    Article  PubMed  Google Scholar 

  28. Remadi JP, Rakotoarivello Z, Marticho P, Trojette F, Benamar A, Poulain H, Tribouilloy C (2004) Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial. J Thorac Cardiovasc Surg 128:436–441

    Article  PubMed  CAS  Google Scholar 

  29. Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A (2006) 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 151:198

    Article  PubMed  Google Scholar 

  30. van Boven WJ, Gerritsen WB, Waanders FG, Haas FJ, Aarts LP (2004) Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and ­biochemical results: a comparison with conventional and off-pump coronary artery bypass grafts concerning global oxidative stress and alveolar function. Perfusion 19:239–246

    Article  PubMed  Google Scholar 

  31. Immer FF, Ackermann A, Gygax E, Stalder M, Englberger L, Eckstein FS, Tevaearai HT, Schmidli J, Carrel TP (2007) Minimal extracorporeal circulation is a promising technique for coronary artery bypass grafting. Ann Thorac Surg 84:1515–1520

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. Castiglioni A, Verzini A, Colangelo N, Nascimbene S, Laino G, Alfieri O (2009) Comparison of minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement: a randomized study. Interact Cardiovasc Thorac Surg 9:37–41

    Article  PubMed  Google Scholar 

  34. Castiglioni A, Verzini A, Pappalardo F, Colangelo N, Torracca L, Zangrillo A, Alfieri O (2007) Minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement. Ann Thorac Surg 83:586–591

    Article  PubMed  Google Scholar 

  35. Mazzei V, Nasso G, Salamone G, Castorino F, Tommasini A, Anselmi A (2007) Prospective randomized comparison of coronary bypass grafting with minimal extracorporeal circulation system (MECC) versus off-pump coronary surgery. Circulation 116:1761–1767

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  37. Curtis N, Vohra HA, Ohri SK (2010) Mini extracorporeal circuit cardiopulmonary bypass system: a review. Perfusion 25:115–124

    Article  PubMed  Google Scholar 

  38. El-Essawi A, Hajek T, Skorpil J, Böning A, Sabol F, Ostrovsky Y, Hausmann H, Harringer W (2011) Are minimized perfusion circuits the better heart lung machines? Final results of a prospective randomized multicentre study. Perfusion 26:470–478

    Article  PubMed  CAS  Google Scholar 

  39. Perthel M, Klingbeil A, El-Ayoubi L, Gerick M, Laas J (2007) Reduction in blood product usage associated with routine use of mini bypass systems in extracorporeal circulation. Perfusion 22:9–14

    Article  PubMed  CAS  Google Scholar 

  40. Bauer A, Diez C, Schubel J, El-Shouki N, Metz D, Eberle T, Hausmann H (2010) Evaluation of hemodynamic and regional tissue perfusion effects of minimized extracorporeal circulation (MECC). J Extra Corpor Technol 42:30–39

    PubMed  Google Scholar 

  41. Panday GF, Fischer S, Bauer A, Metz D, Schubel J, El Shouki N, Eberle T, Hausmann H (2009) Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery. Interact Cardiovasc Thorac Surg 9:832–836

    Article  PubMed  Google Scholar 

  42. Anastasiadis K, Antonitsis P, Haidich AB, Argiriadou H, Deliopoulos A, Papakonstantinou C (2012) Use of minimal extracorporeal circulation improves outcome after heart surgery; a systematic review and meta-analysis of randomized controlled trials. Int J Cardiol Feb 8 [Epub ahead of print]

    Google Scholar 

  43. Anastasiadis K, Asteriou C, Deliopoulos A, Argiriadou H, Karapanagiotidis G, Antonitsis P, Grosomanidis V, Misias G, Papakonstantinou C (2010) Haematological effects of minimized compared to conventional extracorporeal circulation after coronary revascularization procedures. Perfusion 25:197–203

    Article  PubMed  Google Scholar 

  44. Anastasiadis K, Hadjimiltiades S, Antonitsis P (2012) Successful high-risk percutaneous coronary intervention with the use of minimal extracorporeal circulation system. Catheter Cardiovasc Interv 17. doi:10.1002/ccd.242932012 [Epub ahead of print]

  45. Anastasiadis K, Westaby S, Antonitsis P, Argiriadou H, Karapanagiotidis G, Pigott D, Papakonstantinou C (2010) Minimal extracorporeal circulation circuit standby for “off-pump” left ventricular assist device implantation. Artif Organs 34:1156–1168

    Article  PubMed  Google Scholar 

  46. Alevizou A, Dunning J, Park JD (2009) Can a mini-bypass circuit improve perfusion in cardiac surgery compared to conventional cardiopulmonary bypass? Interact Cardiovasc Thorac Surg 8:457–466

    Article  PubMed  Google Scholar 

  47. Harling L, Warren OJ, Martin A, Kemp PR, Evans PC, Darzi A, Athanasiou T (2011) Do miniaturized extracorporeal circuits confer significant clinical benefit without compromising safety? A meta-analysis of randomized controlled trials. ASAIO J 57:141–151

    Article  PubMed  Google Scholar 

  48. Puehler T, Haneya A, Philipp A, Camboni D, Hirt S, Zink W, Lehle K, Rupprecht L, Kobuch R, Diez C, Schmid C (2010) Minimized extracorporeal circulation in coronary artery bypass surgery is equivalent to standard extracorporeal circulation in patients with reduced left ventricular function. Thorac Cardiovasc Surg 58:204–209

    Article  PubMed  CAS  Google Scholar 

  49. Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J, International Consortium for Evidence Based Perfusion, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG (2011) 2011 Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 91:944–982

    Article  PubMed  Google Scholar 

  50. Diez C, Haneya A, Brünger F, Philipp A, Hirt S, Ruppecht L, Kobuch R, Keyser A, Hilker M, Puehler T, Schmid C (2009) Minimized extracorporeal circulation cannot prevent acute kidney injury but attenuates early renal dysfunction after coronary bypass grafting. ASAIO J 55:602–607

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  52. Huybregts RA, Morariu AM, Rakhorst G, Spiegelenberg SR, Romijn HW, de Vroege R, van Oeveren W (2007) Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg 83:1760–1766

    Article  PubMed  Google Scholar 

  53. Anastasiadis K, Argiriadou H, Kosmidis MH, Megari K, Antonitsis P, Thomaidou E, Aretouli E, Papakonstantinou C (2011) Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot study. Heart 97:1082–1088

    Article  PubMed  Google Scholar 

  54. Liebold A, Khosravi A, Westphal B, Skrabal C, Choi YH, Stamm C, Kaminski A, Alms A, Birken T, Zurakowski D, Steinhoff G (2006) Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization. J Thorac Cardiovasc Surg 131:268–276

    Article  PubMed  CAS  Google Scholar 

  55. De Stefano E, Delay D, Horisberger J, von Segesser L (2008) Initial clinical experience with the admiral oxygenator combined with separated suction. Perfusion 23:209–213

    Article  PubMed  Google Scholar 

  56. Nollert G, Schwabenland I, Maktav D, Kur F, Christ F, Fraunberger P, Reichart B, Vicol C (2005) Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammation and coagulation but loss of safety ­margins. Ann Thorac Surg 80:2326–2332

    Article  PubMed  Google Scholar 

  57. Perthel M, El-Ayoubi L, Bendisch A, Laas J, Gerigk M (2007) Clinical advantages of using mini-bypass systems in terms of blood product use, postoperative bleeding and air entrainment: an in vivo clinical ­perspective. Eur J Cardiothorac Surg 31:1070–1075

    Article  PubMed  Google Scholar 

  58. Biancari F, Rimpilainen R (2009) Meta-analysis of randomised trials comparing the effectiveness of miniaturised versus conventional cardiopulmonary bypass in adult cardiac surgery. Heart 95:964–969

    Article  PubMed  CAS  Google Scholar 

  59. Zangrillo A, Garozzo FA, Biondi-Zoccai G, Pappalardo F, Monaco F, Crivellari M, Bignami E, Nuzzi M, Landoni G (2010) Miniaturized cardiopulmonary bypass improves short-term outcome in ­cardiac surgery: a meta-analysis of randomized ­controlled studies. J Thorac Cardiovasc Surg 139:1162–1169

    Article  PubMed  Google Scholar 

  60. Rimpiläinen R, Hautala N, Koskenkari JK, Rimpiläinen J, Ohtonen PP, Mustonen P, Surcel HM, Savolainen ER, Mosorin M, Ala-Kokko TI, Juvonen T (2011) Minimized cardiopulmonary bypass reduces retinal microembolization: a randomized clinical study using fluorescein angiography. Ann Thorac Surg 91:16–22

    Article  PubMed  Google Scholar 

  61. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, Piegas LS, Akar AR, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Vaijyanath P, Reddy S, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Ng J, Chrolavicius S, Yusuf S, CORONARY Investigators (2012) Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 366:1489–1497

    Article  PubMed  CAS  Google Scholar 

  62. Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, Lucke JC, Baltz JH, Novitzky D, Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group (2009) On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 361:1827–1837

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, AHEPA University Hospital Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dr. Kyriakos Anastasiadis, Dr. Polychronis Antonitsis & Dr. Helena Argiriadou

Authors
  1. Dr. Kyriakos Anastasiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dr. Polychronis Antonitsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dr. Helena Argiriadou
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Anastasiadis, K., Antonitsis, P., Argiriadou, H. (2013). MECC—The Perfusionist’s Point of View. One Decade MECC: From a Pioneering to Standard Procedure. In: Principles of Miniaturized ExtraCorporeal Circulation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32756-8_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-32756-8_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-32755-1

  • Online ISBN: 978-3-642-32756-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation