Comparative analysis of perioperative outcomes between hybrid system and MiECC: A prospective pilot study

Abstract

Background: Minimally invasive extracorporeal circulation (MiECC) has been introduced to mitigate the inflammatory response and reduce blood transfusion needs compared to conventional cardiopulmonary bypass (CPB) perioperatively. A hybrid system (HS) that merges aspects of both traditional CPB and MiECC aims to optimize patient perioperative outcomes. This study focuses on comparing the postoperative transfusion rates, intensive care unit (ICU) course, and biochemical parameters between the HS and MiECC. Materials and methods: This prospective, randomized, controlled, single-center study was conducted at Koşuyolu High Specialization Education and Research Hospital, Istanbul from February 2024 to June 2024. Forty patients undergoing isolated coronary artery bypass grafting (CABG) were included, with 20 patients in the HS-group and 20 in the MiECC-group. Data on oxygen delivery management, hemoglobin and platelet values trends, biochemical parameters, the number of red blood cells and platelet units transfused postoperatively, and ICU stay duration were collected. Results: The CPB time was not significantly shorter in the HS group compared to the MiECC group (93.35 ± 33.06 min vs. 108.65 ± 30.02 min, p = 0.134). Hemoglobin levels did not differ significantly between the groups preoperatively, perioperatively, or postoperatively at 6, 12, and 24 h no difference in red blood cells unit transfusion. Indexed oxygen delivery did not differ significantly between the HS and MiECC groups (311.60 ± 28.29 mL/min/m2 vs. 332.25 ± 57.04 mL/min/m2, p = 0.275). Partial pressure of oxygen was higher in the MiECC group (210.90 ± 49.64 mmHg vs. 177.70 ± 70.41 mmHg, p = 0.093), but this difference was also not statistically significant. Biochemical parameters showed notable differences. Postoperative lactate levels were significantly lower in the HS group (2.85 ± 1.20 mmol/L vs. 4.04 ± 1.40 mmol/L, p = 0.009). Conversely, Lactate Dehydrogenase levels during and after CPB were, lower in the MiECC group. Postoperative 6th-hour troponin levels were significantly lower in the HS group (3.188 ± 2.684 ng/mL vs. 4.645 ± 3.422 ng/mL, p = 0.038). Mechanical ventilation duration, ICU stay, and hospital stay were comparable between the two groups, with no significant differences observed. Conclusions: The hybrid system demonstrated comparable results to the MiECC in patients undergoing isolated CABG. No significant differences were observed in CPB time or postoperative blood transfusion requirements. However, the HS group showed favorable biochemical parameters, including significantly lower postoperative lactate levels and troponin levels at 6 h. Indexed oxygen delivery and partial pressure of oxygen were similar between groups, and ICU and hospital stay durations were comparable. These findings suggest that the hybrid system offers outcomes on par with the MiECC approach, with potential benefits in terms of biochemical markers. Further studies with larger sample sizes are needed to validate these results and explore possible advantages in broader clinical settings.

Keywords

• hybrid system
• minimally invasive extracorporeal circulation
• cardiopulmonary bypass
• cardiac surgery
• coronary artery bypass grafting
• transfusion rates