78 K. Kırali et al.: J Extra Corpor Technol 2025, 57, 74 – 81
Table 3. Surgical procedures and CPB duration. Distribution of surgical procedures and mean duration of cardiopulmonary bypass in each group.
|
Hybrid system( n = 20) |
MiECC( n = 20) |
P value |
Coronary artery bypass grafting |
20 |
20 |
1.00 |
Number Anastomoses |
3 ± 1 |
3 ± 1 |
1.00 |
CPB time( min.) |
93.35 ± 33.06 |
108.65 ± 30.02 |
0.134 |
Cross clamp time( min.) |
54.30 ± 25.4 |
63.7 ± 17.3 |
0.181 |
CPB, cardiopulmonary bypass; MiECC, Minimal Invasive Extracorporeal Circulation.
Figure
5. Graphical representation of hemoglobin levels and platelet counts.
( red blood cells and platelets), duration of mechanical ventilation, ICU stay duration, and hospital length of stay. Specifically, biochemical parameters such as lactate, creatinine, troponin, C-reactive protein( CRP), lactate dehydrogenase( LDH) and hematologic values( hemoglobulin, platelet) were measured preoperatively, intraoperatively, and at 6, 12, and 24 h postoperatively to assess the physiological impact of the different CPB techniques.
Statistical analysis
Continuous variables were presented as mean ± standard deviation( SD) and compared using independent t-test or Mann-Whitney U-test where appropriate. Categorical variables were presented as frequencies and percentages and were compared using chi-square( v 2) test. Ap-value of less than 0.05 was considered statistically significant.
Results
The demographic and clinical characteristics, including age, gender distribution, body surface area, and left ventricular ejection fraction, were comparable between the groups with no significant differences( Table 2). The HS-group demonstrated a shorter but nonsignificant CPB and ACC times compared to the MiECC-group. Both groups had an equal number of anastomoses, averaging 3 ± 1 per patient( Table 3). Hemoglobin levels showed no significant differences preoperatively, peri-operatively, and postoperatively at 6, 12, and 24 h between the groups( Figure 5). Platelet counts were also similar between the groups at all measured time points. Red blood cell and platelet transfusion number were similar in both groups( Table 4). Indexed oxygen delivery was in the HS Group( 311.60 ± 28.29 mL / min / m 2) compared to the MiECC Group( 332.25 ± 57.04 mL / min / m 2); the pump flow rate was in the HS group( 5.13 ± 0.44 L / min / m 2) compared to the MiECC Group( 4.56 ± 0.25 L / min / m 2). Conversely, PaO 2 was higher in the MiECC Group, because HS used the continuous PaO 2 monitoring and management system( Ventilation / Blood Flow Ratio Auto-initiation mode) from Spectrum Heart Lung Machine to prevent hyperoxia( 210.90 ± 49.64 mmHg vs. 177.70 ± 70.41 mmHg, p = 0.093). Mean arterial pressure showed no significant difference between the groups( 58.55 ± 3.97 mmHg vs. 57.89 ± 4.22 mmHg, p = 0.61)( Table 5). Biochemical parameters indicated notable differences between the groups. Lactate levels were statistically lower in the HS Group at the 6th hour after CPB( 2.85 ± 1.20 mmol / L vs. 4.04 ± 1.40 mmol / L, p = 0.009). Lactate Dehydrogenase levels and trend during and after CPB was lower in the MiECC group than the HS group( Table 6).
Troponin levels at 6 h post-CPB were also significantly lower in the HS-group( 3.188 ± 2.684 ng / mL vs. 4.645 ± 3.422 ng / mL, p = 0.038). Other parameters, such as creatinine and C-reactive protein, showed no significant differences at most time points( Table 6). Mechanical ventilation duration, ICU stay, and hospital stay was similar in the two groups( Table 7).