76 K. Kırali et al.: J Extra Corpor Technol 2025, 57, 74 – 81
Figure
3. Hybrid system features.
Figure 2. Perioperative use of minimal invasive extracorporeal circulation.
volume adjustments, enhancing the flexibility and adaptability of volume control during surgery. By integrating this reservoir, the HS mitigates the volume management limitations of the MiECC system( Figure 4). The extracorporeal techniques components and features are listed in( Table 1).
Surgical technique
All CABG procedures were performed by the same primary surgeon to ensure consistency across cases. After the standard full median sternotomy and systemic heparinization, the circuit was established through arterial and venous cannulation. An aortic cannula( 20 or 22 Fr) was inserted into the ascending aorta for systemic arterial blood flow, and an atrial two-stage venous cannula( 32 / 40 Fr) was used to facilitate venous return from the right atrium and vena cava inferior. Cardioplegia was delivered using a 7 Fr needle placed in the ascending aorta.
Figure 4. Perioperative use of hybrid system.
For myocardial protection, 1250 mL hypothermic(< 10 ° C) Del Nido cardioplegia solution was administered to achieve and maintain myocardial arrest. Procedures were conducted under mild hypothermia, maintaining the patient’ s temperature at approximately 34 ° C to enhance myocardial and neuroprotective effects. Conduits, such as the internal mammary artery and / or saphenous vein grafts, were harvested and grafted onto the coronary arteries distal to obstructive lesions, with meticulous attention to the distal anastomosis to ensure optimal graft patency and blood flow. Following grafting, the patient was gradually weaned from CPB. The protamine was administered to reverse heparin effects. Hemodynamic stability was supported with inotropic or vasopressor agents as necessary,