Comparison of Minimal Versus Conventional Extracorporeal Circulation in Coronary Surgery
Condition: Coronary Artery Bypass
Study type: Interventional

Summary: 
      The aim of this study is to assess the effect of minimal (MiECC) versus conventional (CECC)
      extracorporeal circulation on perfusion characteristics and remote end-organ protection
      (lungs, brain, kidneys, liver, stomach, intestine), after elective coronary bypass grafting
      (CABG).
    

Detailed description: 
      The aim of this study is to investigate whether coronary surgery with minimal Invasive
      Extracorporeal Circulation (MiECC) offers advantage over conventional CPB (CECC). In order to
      draw an evidence-based conclusion, the investigators aim to evaluate perfusion
      characteristics during coronary surgery with MECC and associated remote end-organ function.
      Improved end-organ protection translates into improved clinical outcome which greatly affects
      quality of life. This is the first study in the literature adequately powered to analyse
      organ pathophysiology during surgery with MECC and at the same time correlating common
      clinical variables with a detailed quality of life evaluation. Superiority of MECC could
      provide firm evidence towards widespread use of MECC in coronary surgery as standard of care.
    

Intervention name(s): Coronary artery bypass grafting with the use of minimal invasive extracorporeal circulation; Coronary artery bypass grafting under conventional extracorporeal circulation
Intervention type(s): Procedure; Procedure
Intervention description(s): We use a prototype AHEPA (modular type IV) circuit comprised of the standard and a standby accessory. Components of the standard circuit include: aortic cannula, three-stage venous cannula, coated tubing, a centrifugal pump, a new-generation membrane oxygenator with integrated arterial filter, a venous air removal device, a soft coated bag and pulmonary artery as well as aortic root vent. In addition, there is a standby hard-shell reservoir in parallel to the venous line, so as to convert the closed system to an open one. The standby component is bridged to the main circuit with an afferent line which is connected just before the VARD sending blood to the hard-shell reservoir and an efferent that re-directs it back to the VARD. A cell-saver device is added to the circuit for collecting shed blood and washing red blood cells for autotransfusion.; A standard open CPB circuit is used, consisting of uncoated PVC tubing, a hard-shell venous reservoir, a microporous membrane oxygenator (Dideco, Mirandola, Italy) and a roller pump (Stöckert S3, Munich, Germany). The circuit contains a 40 μm arterial line blood filter (Dideco, Mirandola, Italy) and it is primed with 1500 mL of a balanced crystalloid/colloid solution (1000 mL of Ringer's solution, 200 mL of mannitol 20%, and 300 mL of hydroxyethyl starch 6%). Cardiotomy as well as sump sucker are integrated to the circuit.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: coronary artery disease; coronary artery bypass grafting; cardiopulmonary bypass; minimal extracorporeal circulation