K. Kırali et al.: J Extra Corpor Technol 2025, 57, 74 – 81 75
Figure 1. Graphical abstract.
and increased morbidity [ 1 ]. To address these issues, the Hybrid System( HS) and Minimally Invasive Extracorporeal Circulation( MiECC) have been developed, offering innovative solutions aimed at reducing these adverse effects. The HS innovative design could play a crucial role in managing systemic inflammatory response syndrome( SIRS), a common complication in patients undergoing CPB. SIRS is characterized by widespread inflammation that can lead to multiple organ dysfunction and increased morbidity [ 2, 3 ]. One of the primary triggers of SIRS during CPB is the exposure of blood to foreign surfaces and air, which activates the body’ s inflammatory pathways. By incorporating a dual chamber and collapsible soft bag, the HS reduces the blood-air interface and the exposure to foreign materials. MiECC systems integrate several advancements, such as reduced priming volumes, minimized air-blood interface, and optimized blood flow patterns, all contributing to better patient outcomes. Despite these benefits, MiECC is not without limitations, and its application may not be suitable for all patients. In response to these limitations, the HS has been proposed, combining elements of both traditional CPB and MiECC [ 1, 3 ]. This hybrid approach aims to leverage the strengths of both systems, optimizing patient outcomes by reducing complications associated with inflammation and transfusions while maintaining the efficacy of traditional CPB( Figure 1). In addition to these mechanical and procedural advancements, biochemical parameters such as lactate, creatinine, troponin, and C-reactive protein levels provide important insights into the physiological impact of CPB and its alternatives [ 4, 5 ]. Monitoring these parameters can help in assessing the effectiveness of different CPB techniques in mitigating systemic inflammation and organ dysfunction.
This prospective, randomized, controlled study, first worldwide study, aimed to compare the perioperative outcomes of patients undergoing on-pump isolated CABG using two different extracorporeal circulation systems: HS-group versus MiECC-group.
Materials and methods
This prospective, randomized, controlled, single-center study was conducted at Kosßuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye from February 2024 to June 2024. The study protocol was approved by the Institutional Review Board( IRB) of Kosßuyolu High Specialization Education and Research Hospital, and written informed consent was obtained from all participants prior to enrollment. This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Forty patients scheduled for isolated CABG requiring CPB were enrolled in this study based on the following inclusion( elective surgery, ability to provide informed consent) and exclusion criteria( emergency or urgent surgery, reoperation, known coagulation disorders). Patients meeting these criteria were randomly assigned to either the HS-group( n = 20) or the MiECC-group( n = 20) usinga computer-generated randomization sequence.
Perfusion techniques
MiECC group: The MiECC system is an extra-corporeal technique without a dynamic reservoir, which is a key distinction from the HS. The absence of a reservoir in MiECC means that blood volume control is inherently more restrictive, as it relies on a closed, minimized circuit. This design minimizes the priming volume, reducing blood dilution and limiting fluid exposure. In this context, the MiECC group used Type I models like Extracorporeal Membrane Oxygenation( ECMO) configuration( Figure 2) from MiECTIS classification [ 6 ].
The HS group: The HS includes a dual-chamber design with a collapsible soft bag that functions as a controlled, adjustable reservoir, which reduces blood-air interface and exposure to foreign materials minimizing systemic inflammatory response( SIRS) risks and reduce gaseous micro-emboly( GE) delivery( Figure 3). This setup allows for better real-time