Vol. 23 No. 3 (2019)
REVIEWS

Haemostasis and minimally invasive extracorporeal circulation

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  • V. Kornev,
  • D. Shelukhin
V. Kornev
All-Russian Centre for Emergency and Radiation Medicine n. a. A. M. Nikiforov, Saint Petersburg
Bio
D. Shelukhin
All-Russian Centre for Emergency and Radiation Medicine n. a. A. M. Nikiforov, Saint Petersburg
DOI: https://doi.org/10.21688/1681-3472-2019-3-84-97

Published 2019-11-27

Keywords

  • biocompatible coatings,
  • cardiac surgery,
  • cardiopulmonary bypass,
  • coagulation,
  • hemostasis,
  • minimally invasive extracorporeal circulation
    • ...More
    Less

How to Cite

Kornev, V., & Shelukhin, D. (2019). Haemostasis and minimally invasive extracorporeal circulation. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 23(3), 84–97. https://doi.org/10.21688/1681-3472-2019-3-84-97

Copyright (c) 2019 Kornev V. I., Shelukhin D. A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Advances in extracorporeal circulation using a minimally invasive circuit have rapidly emerged, and the components and biocoatings of the minimally invasive extracorporeal circuit (MiECC) have improved. The application range of minimally invasive cardiopulmonary bypass has expanded, however the main indications for the use of MiECCs during cardiac surgery have not yet been systematized. To the best of our knowledge, no guidelines for anticoagulant therapy regimens during minimally invasive cardiopulmonary bypass exist, and its effect on blood loss and the activation of coagulation in the perioperative period remain unclear. The present review highlighted the components of the circuit and the practical aspects of using MiECC. We formulated indications for the use of minimally invasive circuits and classified biocompatible coatings used to reduce the contact activation of haemostasis. According to the literature, when performing cardiopulmonary bypass with MiECC, the physiological haemostatic balance is disturbed. The detected changes in plasma haemostasis do not allow drawing conclusions regarding the advantages of MiECC, despite its clinical benefits. Multicentre randomized trials that comply with the rules of the pre-analytical stage of haemostasis and use global tests (thrombin generation test, thrombodynamics test, etc.) are required. The available studies on the haemostatic system using MiECC are not adequate for determining whether MiECCs on a haemostatic system are recommendable. However, MiECCs allow physicians to get closer to the fast track cardiac surgery ideal.

Received 7 October 2019. Revised 14 November 2019. Accepted 18 November 2019.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

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References

  1. Puehler T., Haneya A., Philipp A., Zausig Y.A., Kobuch R., Diez C., Birnbaum D.E., Schmid C. 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):459-64. PMID: 20851618. https://doi.org/10.1016/j.ejcts.2010.08.006
  2. Foltan M., Philipp A., Birnbaum D. Extended use of ECC. Perfusion. 2007;22(3):173-8. PMID: 18018396. https://doi.org/10.1177/0267659107076873
  3. Anastasiadis K., Bauer A., Antonitsis P., Gygax E., Schaarschmidt J., Carrel T. Minimal invasive extra-corporeal circulation (MiECC): a revolutionary evolution in perfusion. Interact Cardiovasc Thorac Surg. 2014;19(4):541-2. PMID: 25536672. https://doi.org/10.1093/icvts/ivu304
  4. Anastasiadis K., Antonitsis P., Asteriou C., Argiriadou H., Deliopoulos A., Konstantinou D., Grosomanidis V., Tossios P. Quantification of operational learning in minimal invasive extracorporeal circulation. Artif Organs. 2017;41(7):628-636. PMID: 27925235. https://doi.org/10.1111/aor.12813
  5. Anastasiadis K., Murkin J., Antonitsis P., Bauer A., Ranucci M., Gygax E., Schaarschmidt J., Fromes Y., Philipp A., Eberle B., Punjabi P., Argiriadou H., Kadner A., Jenni H., Albrecht G., van Boven W., Liebold A., de Somer F., Hausmann H., Deliopoulos A., El-Essawi A., Mazzei V., Biancari F., Fernandez A., Weerwind P., Puehler T., Serrick C., Waanders F., Gunaydin S., Ohri S., Gummert J., Angelini G., Falk V., Carrel T. 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):647-62. PMID: 26819269. https://doi.org/10.1093/icvts/ivv380
  6. Kowalewski M., Pawliszak W., Raffa G.M., Malvindi P.G., Kowalkowska M.E., Zaborowska K., Kowalewski J., Tarelli G., Taggart D.P., Anisimowicz L. 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 778patients. Eur J Cardiothorac Surg. 2016;49(5):1428-40. PMID: 26537755. https://doi.org/10.1093/ejcts/ezv387
  7. Anastasiadis K., Antonitsis P., Argiriadou H., Deliopoulos A., Grosomanidis V., Tossios P. Modular minimally invasive extracorporeal circulation systems; can they become the standard practice for performing cardiac surgery? Perfusion. 2015;30(3):195-200. PMID: 25564510. https://doi.org/10.1177/0267659114567555
  8. Remadi J.P., Marticho P., Butoi I., Rakotoarivelo Z., Trojette F., Benamar A., Beloucif S., Foure D., Poulain H.J. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg. 2004;77(6):2172-5. PMID: 15172290. https://doi.org/10.1016/S0003-4975(03)00977-9
  9. Remadi J.P., 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. PMID: 16368318. https://doi.org/10.1016/j.ahj.2005.03.067
  10. Rufa M., Schubel J., Ulrich C., Schaarschmidt J., Tiliscan C., Bauer A., Hausmann H. 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):102-7. PMID: 25911678. https://doi.org/10.1093/icvts/ivv103
  11. Remadi J.P., Rakotoarivello Z., Marticho P., Trojette F., Benamar A., Poulain H., Tribouilloy C. Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial. J Thorac Cardiovasc Surg. 2004;128(3):436-41. PMID: 15354105. https://doi.org/10.1016/j.jtcvs.2004.01.041
  12. Starinieri P., Declercq P.E., Robic B., Yilmaz A., Van Tornout M., Dubois J., Mees U., Hendrikx M. A comparison between minimized extracorporeal circuits and conventional extracorporeal circuits in patients undergoing aortic valve surgery: is minimally invasive extracorporeal circulation' just low prime or closed loop perfusion? Perfusion. 2017;32(5):403-408. PMID: 28553780. https://doi.org/10.1177/0267659117691814
  13. Basciani R., Kröninger F., Gygax E., Jenni H., Reineke D., Stucki M., Hagenbuch N., Carrel T., Eberle B., Erdoes G. Cerebral microembolization during aortic valve replacement using minimally invasive or conventional extracorporeal circulation: A randomized trial. Artif Organs. 2016;40(12):E280-E291. PMID: 27283935. https://doi.org:10.1111/aor.12744
  14. Halfwerk F.R., Knol K., Mariani S., Grandjean J.G., Mecozzi G. Randomized trial of miniaturized versus standard extracorporeal circulation in aortic valve surgery. Ann Thorac Surg. 2019;108(1):37-44. PMID:30771329. https://doi.org/10.1016/j.athoracsur.2019.01.019
  15. Gygax E., Kaeser H.U., Stalder M., Gahl B., Rieben R., Carrel T., Erdoes G. Type II minimal-invasive extracorporeal circuit for aortic valve replacement: a randomized controlled trial. Artif Organs. 2018;42(6):620-9. PMID: 29435996. https://doi.org/10.1111/aor.13093
  16. Di Eusanio M., Vessella W., Carozza R., Capestro F., D'Alfonso A., Zingaro C., Munch C., Berretta P. Ultra fast-track minimally invasive aortic valve replacement: going beyond reduced incisions. Eur J Cardiothorac Surg. 2018;53(suppl_2):ii14-ii18. PMID: 29370357. https://doi.org/10.1093/ejcts/ezx508
  17. nd International Symposium on Minimal Invasive Extracorporeal Technologies Athens, Greece, 9-11 June 2016. Interact Cardiovasc Thorac Surg. 2016;23(4):i1-i4. https://doi.org/10.1093/icvts/ivw269
  18. Palombo D., Valenti D., Gaggiano A., Lupo M., Borin P. Early experience with the minimal extracorporeal circulation system (MECC) during thoracoabdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2004;27(3):324-6. PMID: 14760604. https://doi.org/10.1016/j.ejvs.2003.11.012
  19. Anastasiadis K., Antonitsis P., Argiriadou H., Khayat A., Papakonstantinou C., Westaby S. Use of minimal extracorporeal circulation circuit for left ventricular assist device implantation. ASAIO J. 2011;57(6):547-9. PMID: 21970982. https://doi.org/10.1097/MAT.0b013e318232d5d5
  20. Дворянчикова В.А., Пасечник И.Н., Цепенщиков В.А., Губайдуллин Р.Р., Пиданов О.Ю., Васягин Е.В. Пути предотвращения пост-перфузионного синдрома при операциях на сердце у взрослых. Доктор.Ру. 2017;6(135):12-18. [Dvoryanchikova V.A., Pasechnik I.N., Tsepenshchikov V.A., Gubaidullin R.R., Pidalov O.Yu., Vasyagin E.V. Preventing postperfusion syndrome in adults after cardiac surgery. Doctor.Ru. 2017;6(135):12-18. (In Russ.)]
  21. Momin A., Sharabiani M., Mulholland J., Yarham G., Reeves B., Anderson J., Angelini G. Miniaturized cardiopulmonary bypass: the Hammersmith technique. J Cardiothorac Surg. 2013;8:143. PMID: 23731623. https://doi.org/10.1186/1749-8090-8-143
  22. Perthel M., El-Ayoubi L., Bendisch A., Laas J., Gerigk M. 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. 2007;31(6):1070-5; discussion 1075. PMID: 17337198. https://doi.org/10.1016/j.ejcts.2007.01.065
  23. Ganushchak Y.M., Severdija E.E.,Simons A.P., van Garsse L., Weerwind P.W. Can minimized cardiopulmonary bypass systems be safer? Perfusion. 2012;27(3):176-82. PMID: 22337763. https://doi.org/10.1177/0267659112437902
  24. Bauer A., Hausmann H., Schaarschmidt J., Scharpenberg M., Troitzsch D., Johansen P., Nygaard H., Eberle T., Hasenkam J.M. Shed-blood-separation and cell-saver: an integral Part of MiECC? Shed-blood-separation and its influence on the perioperative inflammatory response during coronary revascularization with minimal invasive extracorporeal circulation systems - a randomized controlled trial. Perfusion. 2018;33(2):136-47. PMID: 28937313. https://doi.org/10.1177/0267659117728195
  25. Stehouwer M.C., Boers C., de Vroege R., C Kelder J., Yilmaz A., Bruins P. Clinical evaluation of the air removal characteristics of an oxygenator with integrated arterial filter in a minimized extracorporeal circuit. Int J Artif Organs. 2011;34(4):374-82. PMID: 21534248. https://doi.org/10.5301/IJAO.2011.7749
  26. Kutschka I., Schönrock U., El Essawi A., Pahari D., Anssar M., Harringer W. A new minimized perfusion circuit provides highly effective ultrasound controlled deairing. Artif Organs. 2007;31(3):215-20. PMID: 17343697. https://doi.org/10.1111/j.1525-1594.2007.00367.x
  27. Panday G.F., Fischer S., Bauer A., Metz D., Schubel J., El Shouki N., Eberle T., Hausmann H. Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery. Interact Cardiovasc Thorac Surg. 2009;9(5):832-6. PMID: 19671581. https://doi.org/10.1510/icvts.2009.206466
  28. Aboud A., Mederos-Dahms H., Liebing K., Zittermann A., Schubert H., Murray E., Renner A., Gummert J., Börgermann J. Counteracting negative venous line pressures to avoid arterial air bubbles: an experimental study comparing two different types of miniaturized extracorporeal perfusion systems. BMC Anesthesiol. 2015;15:81. PMID: 26021999. https://doi.org/10.1186/s12871-015-0058-0
  29. Menkis A.H., Martin J., Cheng D.C., Fitzgerald D.C., Freedman J.J., Gao C., Koster A., Mackenzie G.S., Murphy G.J., Spiess B., Ad N. Drug, devices, technologies, and techniques for blood management in minimally invasive and conventional cardiothoracic surgery: a consensus statement from the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011. Innovations (Phila). 2012;7(4):229-41. PMID: 23123988. https://doi.org/10.1097/IMI.0b013e3182747699
  30. Bauer A., Hausmann H., Schaarschmidt J., Scharpenberg M., Troitzsch D., Johansen P., Nygaard H., Eberle T., Hasenkam J.M. Shed-blood-separation and cell-saver: an integral Part of MiECC? Shed-blood-separation and its influence on the perioperative inflammatory response during coronary revascularization with minimal invasive extracorporeal circulation systems - a randomized controlled trial. Perfusion. 2018;33(2):136-147. PMID: 28937313. https://doi.org/10.1177/0267659117728195
  31. Anastasiadis K., Antonitsis P., Ranucci M., Murkin J. Minimally invasive extracorporeal circulation (MiECC): towards a more physiologic perfusion. J Cardiothorac Vasc Anesth. 2016;30(2):280-1. PMID: 27013118. https://doi.org/10.1053/j.jvca.2016.01.018
  32. Ranucci M., Baryshnikova E. Inflammation and coagulation following minimally invasive extracorporeal circulation technologies. J Thorac Dis. 2019;11(Suppl 10):S1480-S1488. PMID: 31293797. https://doi.org/10.21037/jtd.2019.01.27
  33. Ganushchak Y.M., Körver E.P., Yamamoto Y., Weerwind P.W. Versatile minimized system--a step towards safe perfusion. Perfusion. 2016;31(4):295-9. PMID: 26354746. https://doi.org/10.1177/0267659115604711
  34. Elçi M.E., Kahraman A., Mutlu E., İspir C.S. Еffects of minimal extracorporeal circulation on the systemic inflammatory response and the need for transfusion after coronary bypass grafting surgery. Cardiol Res Pract. 2019;4;2019:1726150. PMID: 31275639. https://doi.org/10.1155/2019/1726150
  35. Fromes Y., Gaillard D., Ponzio O., Chauffert M., Gerhardt M.F., Deleuze P., Bical O.M. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002;22(4):527-33. PMID: 12297167. https://doi.org/10.1016/s1010-7940(02)00372-x
  36. El-Essawi A., Morjan M., Breitenbach I., Bechri A., Brouwer R., Harringer W. Modular minimal invasive extracorporeal circuits: another step toward universal applicability? Perfusion. 2017;32(7):598-605. PMID: 28578622. https://doi.org/10.1177/0267659117712404
  37. Ellam S., Pitkänen O., Lahtinen P., Musialowicz T., Hippeläinen M., Hartikainen J., Halonen J. Impact of minimal invasive extracorporeal circulation on the need of red blood cell transfusion. Perfusion. 2019;34(7):605-12. PMID: 31027452. https://doi.org/10.1177/0267659119842811
  38. Tschopp S., Eckstein F., Matt P. Low-volume cardioplegia and myocardial protection in coronary artery bypass graft surgery. Thorac Cardiovasc Surg. 2019;67(6):484-487. PMID: 30071564. https://doi.org/10.1055/s-0038-1667322
  39. Koechlin L., Zenklusen U., Doebele T., Rrahmani B., Gahl B., Berdajs D., Grapow M.T.R., Eckstein F.S., Reuthebuch O. Clinical implementation of a novel myocardial protection pathway in coronary artery bypass surgery with minimal extracorporeal circulation. Perfusion. 2019;34(4):277-84. PMID: 30565517. https://doi.org/10.1177/0267659118815287
  40. Koechlin L., Rrahmani B., Gahl B., Berdajs D., Grapow M.T.R., Eckstein F.S., Reuthebuch O. Microplegia versus cardioplexol in coronary artery bypass surgery with minimal extracorporeal circulation: comparison of two cardioplegia concepts. Thorac Cardiovasc Surg. 2019. PMID: 31022735. https://doi.org/10.1055/s-0039-1687843
  41. Haneya A., Puehler T., Philipp A., Diez C., Ried M., Kobuch R., Hirt S.W., Metterlein T., Schmid C., Lehle K. Coronary artery bypass grafting in patients with type 2 diabetes mellitus: a comparison between minimized and conventional extracorporeal circulation. ASAIO J. 2011;57(6):501-6. PMID: 22036720. https://doi.org/10.1097/MAT.0b013e318236e7af
  42. Ried M., Haneya A., Kolat P., Philipp A., Kobuch R., Hilker M., Schmid C., Diez C. Emergency coronary artery bypass grafting using minimized versus standard extracorporeal circulation--a propensity score analysis. J Cardiothorac Surg. 2013;8:59. PMID: 23547910. https://doi.org/10.1186/1749-8090-8-59
  43. Haneya A., Philipp A., Von Suesskind-Schwendi M., Diez C., Hirt S.W., Kolat P., Attmann T., Schoettler J., Zausig Y., Ried M., Schmid C. Impact of minimized extracorporeal circulation on outcome in patients with preoperative anemia undergoing coronary artery bypass surgery. ASAIO J. 2013;59(3):269-74. PMID: 23644614. https://doi.org/10.1097/MAT.0b013e3182894351
  44. Baikoussis N.G., Papakonstantinou N.A., Apostolakis E. The "benefits" of the mini-extracorporeal circulation in the minimal invasive cardiac surgery era. J Cardiol. 2014;63(6):391-6. PMID: 24629908. https://doi.org/10,1016 / j.jjcc.2013.12.014
  45. Linden M.D. The hemostatic defect of cardiopulmonary bypass. J Thromb Thrombolysis. 2003;16(3):129-47.PMID:15087599. https://doi.org/10.1023/b:thro.0000024051.12177.e9
  46. Johnell M., Elgue G., Larsson R., Larsson A., Thelin S., Siegbahn A. Coagulation, fibrinolysis, and cell activation in patients and shed mediastinal blood during coronary artery bypass grafting with a new heparin-coated surface. J Thorac Cardiovasc Surg. 2002;124(2):321-32. PMID: 12167793. https://doi.org/10.1067/mtc.2002.122551
  47. Mirow N., Brinkmann T., Minami K., Tenderich G., Schulte-Eistrup S., Kleesiek K., Körfer R. Low dose systemic heparinization combined with heparin-coated extracorporeal circulation. Effects related to platelets. J Cardiovasc Surg (Torino). 2001;42(5):579-85. PMID: 11562580.
  48. Wiesenack C., Liebold A., Philipp A., Ritzka M., Koppenberg J., Birnbaum D.E., Keyl C. Four years experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs. 2004;28(12):1082-8. PMID: 15554936. https://doi.org/10.1111/j.1525-1594.2004.00030.x
  49. Haneya A., Philipp A., Camboni D., Fabricius A., Diez C., Kobuch R., Hirt S.W., Keyser A., Rupprecht L., Hilker M., Schmid C., Puehler T. Successful coronary artery bypass grafting with the aid of a portable minimized extracorporeal life support system. ASAIO J. 2012;58(4):337-42. PMID: 22717590. https://doi.org/10.1097/MAT.0b013e31825fdfcb
  50. Anastasiadis K., Antonitsis P., Bauer A., Carrel T. Minimal invasive Extracorporeal Technologies international Society (MiECTiS). Minimal invasive extracorporeal circulation should become the standard practice in coronary revascularization surgery. Eur J Cardiothorac Surg. 2016;50(1):189. PMID: 26834234. https://doi.org/10.1093/ejcts/ezw004
  51. Formica F., Mariani S., Broccolo F., Caruso R., Corti F., D'Alessandro S., Amigoni P., Sangalli F., Paolini G. 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):600-6. PMID: 24172265. https://doi.org/10.1097/MAT.0b013e3182a817aa
  52. Freundt M., Ried M., Philipp A., Diez C., Kolat P., Hirt S.W., Schmid C., Haneya A. Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly. Perfusion. 2016;31(2):143-8. PMID: 26034198. https://doi.org/10.1177/0267659115588634
  53. Kolat P., Ried M., Haneya A., Philipp A., Kobuch R., Hirt S., Hilker M., Schmid C., Diez C. Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal circulation. J Cardiothorac Surg. 2014;9:143. PMID: 25185963. https://doi.org/10.1186/s13019-014-0143-3
  54. El-Essawi A., Breitenbach I., Haupt B., Brouwer R., Baraki H., Harringer W. Impact of minimally invasive extracorporeal circuits on octogenarians undergoing coronary artery bypass grafting. Have we been looking in the wrong direction? Eur J Cardiothorac Surg. 2017;52(6):1175-81. PMID: 28582490. https://doi.org/10.1093/ejcts/ezx156
  55. Winkler B., Heinisch P.P., Zuk G., Zuk K., Gahl B., Jenni H.J., Kadner A., Huber C., Carrel T. Minimally invasive extracorporeal circulation: excellent outcome and life expectancy after coronary artery bypass grafting surgery. Swiss Med Wkly. 2017;147:w14474. PMID: 28695560. https://doi.org/10.4414/smw.2017.14474
  56. Biran R., Pond D. Heparin coatings for improving blood compatibility of medical devices. Adv Drug Deliv Rev. 2017;112:12-23. PMID: 28042080. https://doi.org/10.1016/j.addr.2016.12.002
  57. Weber M., Steinle H., Golombek S., Hann L., Schlensak C., Wendel H.P., Avci-Adali M. Blood-contacting biomaterials: in vitro evaluation of the hemocompatibility. Front Bioeng Biotechnol. 2018;6:99. PMID: 30062094. https://doi.org/10.3389/fbioe.2018.00099
  58. Kiessling A.H., Keller H., Moritz A. Prospective, randomized un-blinded three arm controlled study in coronary artery revascularization with Minimal invasive Extracorporeal Circulation Systems (MiECC): surrogate parameter analysis of biocompatibility. Heart Surg Forum. 2018;21(3):E179-E186. PMID: 29893677. https://doi.org/10.1532/hsf.1946
  59. Haneya A., Philipp A., Diez C., Ried M., Puehler T., Camboni D., Zausig Y., Lehle K., Schmid C. Comparison of two different minimized extracorporeal circulation systems: hematological effects after coronary surgery. ASAIO J. 2009;55(6):592-7. PMID: 19812477. https://doi.org/10.1097/MAT.0b013e3181be2f5c
  60. Muraki R., Totsugawa T., Nagata K., Nakajima K., Oshita T., Arimichi M., Yoshitaka H., Sakaguchi T. Cell salvage processing of residual cardiopulmonary bypass volume in minimally invasive cardiac surgery. Heart Vessels. 2019;34(8):1280-6. PMID: 30810800. https://doi.org/10.1007/s00380-019-01365-6
  61. Liu Y., Tao L., Wang X., Cui H., Chen X., Ji B. Beneficial effects of using a minimal extracorporeal circulation system during coronary artery bypass grafting. Perfusion. 2012;27(1):83-9. PMID: 21987667. https://doi.org/10.1177/0267659111424636
  62. Wahba A., Rothe G., Lodes H., Barlage S., Schmitz G. The influence of the duration of cardiopulmonary bypass on coagulation, fibrinolysis and platelet function. Thorac Cardiovasc Surg. 2001;49(3):153-6. PMID: 11432473. https://doi.org/10.1055/s-2001-14292
  63. Liu Y., Cui H.J., Tao L., Chen X.F. Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft. [Article in Chinese]. Zhonghua Wai Ke Za Zhi. 2011;49(4):307-10. PMID: 21612694.
  64. Yuruk K., Bezemer R., Euser M., Milstein D.M., de Geus H.H., Scholten E.W., de Mol B.A., Ince C. 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):364-70. PMID: 22700685. https://doi.org/10.1093/icvts/ivs271
  65. Anastasiadis K., Antonitsis P., Kostarellou G., Kleontas A., Deliopoulos A., Grosomanidis V., Argiriadou H. Minimally invasive extracorporeal circulation improves quality of life after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2016;50(6):1196-203. PMID: 27307483. https://doi.org/10.1093/ejcts/ezw210
  66. Erdoes G., Dietrich W., Stucki M.P., Merz T.M., Angelillo-Scherrer A., Nagler M., Carrel T., Eberle B. Short-term recovery pattern of plasma fibrinogen after cardiac surgery: a prospective observational study. PLoS One. 2018;13(8):e0201647. PMID: 30075017. https://doi.org/10.1371/journal.pone.0201647
  67. Bauer A., Hausmann H., Schaarschmidt J., Szlapka M., Scharpenberg M., Eberle T., Hasenkam J.M. Is 300 Seconds ACT Safe and Efficient during MiECC Procedures? Thorac Cardiovasc Surg. 2019;67(3):191-202. PMID: 29290078. https://doi.org/10.1055/s-0037-1609019
  68. Lindholm L., Westerberg M., Bengtsson A., Ekroth R., Jensen E., Jeppsson A. A closed perfusion system with heparin coating and centrifugal pump improves cardiopulmonary bypass biocompatibility in elderly patients. Ann Thorac Surg. 2004;78(6):2131-8; discussion 2138. PMID: 15561050. https://doi.org/10.1016/j.athoracsur.2004.06.011
  69. Wippermann J., Albes J.M., Hartrumpf M., Kaluza M., Vollandt R., Bruhin R., Wahlers T. Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parametersof coagulation and inflammatory system. Eur J Cardiothorac Surg. 2005;28(1):127-32. PMID: 15939621. https://doi.org/10.1016/j.ejcts.2005.03.032
  70. Nollert G., Schwabenland I., Maktav D., Kur F, Christ F., Fraunberger P., Reichart B., Vicol C. Miniaturized cardiopulmonary bypass in coronary artery bypass surgery: marginal impact on inflammation and coagulation but loss of safety margins. Ann Thorac Surg. 2005;80(6):2326-32. PMID: 16305899. https://doi.org/10.1016/j.athoracsur.2005.05.080
  71. El-Sabbagh A.M., Toomasian C.J., Toomasian J.M., Ulysse G., Major T., Bartlett R.H. Effect of air exposure and suction on blood cell activation and hemolysis in an in vitro cardiotomy suction model. ASAIO J. 2013;59(5):474-9. PMID: 23896771. https://doi.org/10.1097/MAT.0b013e31829f0e6e