K. Kırali et al.: J Extra Corpor Technol 2025, 57, 74 – 81 77
Table 1. Extracorporeal techniques details.
Hybrid System Components: The Hybrid System employed in the study was manufactured by Spectrum Medical and featured advanced components aimed at improving patient outcomes( Figure 1). Key components included: Oxygenator: Spectrum Medical VT200, providing efficient oxygenation throughout the surgical procedure.
Circuit Management: Filled with 1000 mL crystalloid solution and administered with 300 IU / kg of sodium heparin to achieve an activated clotting time of 480’’ s prior to CPB.
Perfusion System: Quantum perfusion system, delivering reliable blood flow with online continuous blood measurement via VIPER( Perfusion Record).
MiECC Components: The MiECC system employed a closed type III circuit using the Stöckert S5 heart-lung machine( LivaNova, London, UK)( Figure 3). Key components included: Venous-Arterial Line: Diameter 3 / 8, integrated with a venous bubble-trap( LivaNova, London, UK). Oxygenator: Polypropylene fiber oxygenator( Ispire 6 F, LivaNova, London, UK) with Biopassive Coating Phisio( LivaNova, London, UK).
Circuit Management: Filled with 1000 mL crystalloid solution and administered with 300 IU / kg of sodium heparin to achieve an activated clotting time of 480’’ s prior to CPB.
Monitoring: DO 2 management monitoring was used during CPB, alongside arterial blood gas analysis using alpha-stat management at 37 ° C.
Hybrid Venous Reservoir: Includes a dual chamber for efficient blood suction management and a collapsible soft bag to minimize blood contact with foreign materials and reduce air exposure( Figure 2). Heat Exchanger: Quantum Standard Heat Exchanger High Flow 3 / 8, ensuring precise thermal control. Myocardial Protection: Utilized del Nido solution cardioplegia, administered every 90 minutes via a closed circuit with heat exchanger ensuring myocardial protection throughout the procedure. Ventilation Module: Quantum ventilation module, supporting optimal gas blending and management of atmospheric and hypobaric ventilation.
Centrifugal Pump: Revolution Pump( LivaNova, London, UK).
Bubble Detection System: Used to remove air from the bubble trap and the circuit( Stöckert, LivaNova).
Myocardial Protection: Utilized del Nido solution cardioplegia, administered every 90 minutes via a closed circuit with heat exchanger ensuring myocardial protection throughout the procedure.
Table 2. Patient characteristics. Demographic and clinical characteristics of patients in the Hybrid System and MiECC groups.
Characteristic |
Hybrid system( n = 20) |
MiECC( n = 20) |
P-value |
Mean age( years) |
63.9 ± 6.96 |
59.2 ± 8.09 |
0.056 |
Male sex |
18( 90 %) |
17( 85 %) |
0.633 |
Mean body surface area( m 2) |
1.91 ± 0.11 |
1.94 ± 0.13 |
0.478 |
Mean left ventricular ejection fraction(%) |
59.2 ± 11.84 |
58 ± 10.05 |
0.721 |
MiECC: minimal invasive extracorporeal circulation.
and the cannulas were removed carefully. Hemostasis was confirmed, the chest was irrigated, and the sternum was closed in layers. The patient was then transferred to the intensive care unit( ICU) for postoperative monitoring.
Anesthesia management
Preoperative assessment includes optimizing comorbidities, fasting per ASA guidelines, and premedication with midazolam( 1 – 2 mg IV) as needed. Induction includes standard monitoring( electrocardiography, pulse oximetry, arterial line, central venous access), Bispectral Index( BIS) to monitor anesthesia depth, and Near-Infrared Spectroscopy( NIRS) for cerebral oxygenation. Initial medications include midazolam( 0.03 – 0.05 mg / kg IV), fentanyl( 5 – 10 lg / kg IV), and either propofol( 0.5 – 1 mg / kg IV) or etomidate( 0.2 – 0.3 mg / kg IV) based on patient stability, followed by rocuronium( 0.6 – 1 mg / kg IV) for intubation. Maintenance of anesthesia involves isoflurane or sevoflurane( 0.5 – 1.5 MAC) or TIVA, with continuous infusion of fentanyl( 1 – 5 lg / kg / h) and rocuronium, guided by BIS to maintain optimal depth and NIRS to monitor brain oxygenation. Hemodynamic stability is closely monitored with the transesophageal echocardiography and managed using vasoactive. During CPB, heparin was administered to maintain anticoagulation, and anesthesia was adjusted while closely monitoring acid-base balance. Upon separation from CPB, protamine is administered to reverse heparin, and hemodynamic stability is re-established. For emergence, neuromuscular blockade is reversed, and the patient is transferred to the ICU while sedated and intubated for postoperative monitoring. Data collection
Data collected included preoperative demographics( age, gender, left ventricular function), intraoperative parameters such as CPB and aortic cross-clamp time( ACC), and indexed oxygen delivery( DO 2 i), partial arterial oxygen pressure( PaO 2), and postoperative outcomes including transfusion requirements