Standard Cardio Pulmonary Bypass (SCPB) is known for a lot of negative side effects: large foreign surface, cardiotomy suction, massive hemodilution, high volume cardioplegie, a roller pump and direct blood gas interface. The use of a Minimall ExtraCorporeal Circulation system (MiECC) tries to eliminate all this side effects.
The course in the years
SCPB is a safe golden standard for more then 40 years. But SCPB can cause a major systemic inflammatory response, that is why there is allways interest in less invasive techniques. We tried to make it less invasive for our patients with the introduction of the MECC (Minimized Extra Corporeal Circulation, Getinge) system on a HL30 heart lung machine (Getinge). In recent years we even did a MiECC on a Cardiohelp system. More recently we used a similar system with a revolution pump (Livanova) on the Quantum heart lung machine (Spectrum Medical – Medtronic).
To be able to perform all kinds of surgery with one systeem we are now in the middle of the development of a so called hybrid system.
The MiECC system at our clinics
The MiECC is a closed system, without a venous reservoir, so blood will be most of the time inside the patient instead of in an open cardiotomy reservoir.
The centrifugal pump will provide an active venous drainage of the patient. The negative pressure that a centrifugal pump can create is limited at -60 mmHg
The system is used with the Califiore bloodcardioplegia technique.
The total priming volume of the system can be further reduced by autologous blood priming. The aim is a small and biocompatible system, what should lead to minimal heamodilution, reduced blood transfusion, reduced inflammatory response and reduced the amount of haemolysis.
The systemic heparinization can be reduced to 1,5 mg/kg body weight, activated clotting times of 300 sec and more are common in this technique.
The MiECC has a specific oxygenator with diffuse fibres, it is not possible to give anaesthetic gas over this system.
