Abstract

Objective

Coronary artery bypass grafting (CABG) is one of the most widely used and effective treatment modalities for coronary artery disease and is most commonly performed with cardiopulmonary bypass (CPB). Minimal invasive extracorporeal circulation (MiECC) is a perfusion strategy designed to reduce CPB–related adverse effects through a closed–circuit configuration and reduced priming volume. This study aimed to compare the effects of conventional centrifugal–pump CPB and MiECC systems on perioperative patient recovery in isolated CABG surgery.

Materials and Methods

This prospective descriptive study was conducted between May and September 2025 at University of Health Sciences Türkiye, Koşuyolu Training and Research Hospital in İstanbul. Sixty patients undergoing elective isolated CABG were allocated to two groups: the MiECC group (n = 30) and the conventional CPB group using a centrifugal pump (n = 30). Preoperative, intraoperative, and postoperative parameters were compared, including fluid balance, lactate difference, blood transfusion, activated clotting time (ACT), drainage volume, transfusion requirements, duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stay, and laboratory values measured at 0, 6, 24, and 48 hours and on postoperative day 5.

Results

Preoperative demographic characteristics, comorbidities, laboratory values, and intraoperative variables, including the number of anastomoses, CPB duration, and aortic cross–clamp time, were similar between the groups. The MiECC group demonstrated significantly lower intraoperative fluid balance and ACT values. Postoperative drainage volume during the first 24 hours, allogeneic blood product utilization, and ICU length of stay were also significantly reduced. In addition, hematocrit and hemoglobin levels were better preserved in the early postoperative period, while lactate dehydrogenase levels during the first 48 hours and total bilirubin levels at postoperative hour 6 were significantly lower in the MiECC group.

Conclusion

In conclusion, MiECC was associated with reduced hemodilution, improved preservation of blood cellular components, decreased postoperative bleeding and transfusion requirements, and a shorter ICU length of stay in patients undergoing isolated CABG. The use of MiECC may be recommended with appropriate patient selection and standardized perfusion protocols.