NEW YORK (Reuters Health) - Minimally invasive cardiopulmonary bypass (MICPB) improves outcomes after coronary artery revascularization, compared with conventional cardiopulmonary bypass (CPB), according to a report in the April 15th Critical Care.

"During the last 4-5 years it appeared quite clear that on-pump surgery was still representing about 85% of the surgical cases, and that the answer to CPB complications was not simply avoiding CPB, but rather improving again the quality of the system," Dr. Marco Ranucci from IRCCS Policlinico S. Donato, Milan, Italy told Reuters Health. "The present study provides the information that a multifactorial improvement of CPB circuits, represented by MICPB, is effective in limiting postoperative complications."

Dr. Ranucci and Dr. Giuseppe Isgro investigated the effects of a MICPB strategy on the outcome of nearly 1700 patients who underwent coronary artery bypass graft (CABG) surgery.

Patients in the MICPB group had significantly less postoperative bleeding and lower postoperative peak values of both serum creatinine and bilirubin than did patients in the CPB (control) group, the authors report.

MICPB patients were less likely to require the use of intraaortic balloon pump and were less likely to experience atrial fibrillation, ventricular arrhythmias, cardiac arrest, and peripheral thromboembolism, the results indicate.

As a result of these differences in morbidity, the researchers note, MICPB patients had shorter ICU stays, and their intubation durations and ICU and hospital stays were significantly shorter. Hospital mortality did not differ between the groups.

In a multivariable analysis, MICPB was independently associated with a better outcome.

"I personally believe that the next step for improving cardiopulmonary bypass is to address the quality of organ perfusion," Dr. Ranucci said. "There is an increasing body of evidence that 10-15% of our patients suffer from an inadequate perfusion during CPB, namely at the level of kidney and gut mucosa. We are strongly involved in identifying monitoring tools which could offer metabolic information about the adequacy of perfusion and oxygen delivery during CPB."