**Miniaturized Extracorporeal Circulation**

Francesco Formica and Giovanni Paolini

*Cardiac Surgery Clinic, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy* 

## **1. Introduction**

134 Front Lines of Thoracic Surgery

Moreira, L.F. 2001. Current perspectives of partial left ventriculectomy in the treatment of dilated cardiomyopathy. *Eur. J. Cardio-thorac. Surg.*, Vol. 19, 2001, pp. 54–60 Oganov, R. & Maslennikova, G. 2000. Cardiovascular diseases in Russian Federation in the

Patel, H.J. 1997. Stabilization of chronic remodeling by asynchronous cardiomyoplasty in

Popovic, Z. 1998. Effects of partial left ventriculectomy on left ventricular performance in

Popovic, Z. 2001. Functional capacity late after partial left ventriculectomy: relation to

Ratcliffe, M.B. 1998. The effect of ventricular volume reduction surgery in the dilated, poorly

Rosenberg, V. 2003. Nepomnyashchih, L. Pathomorphological criteria of postinfarction heart

Rosenberg, V. 2003. Postinfarction heart remodeling: variants of pathomorphological

Sabbah, H.N. 2001. Prevention of progressive left ventricular dilation with the Acorn cardiac

Salikova, S. et al. 2002. Morphological aspects of heart remodeling with chronic heart failure.

Sartipy, U. et al. 2006. Risk factors for mortality and hospital re-admission after surgical ventricular restoration. *Eur. J. Cardiothorac Surg*, Vol. 30, 2006, pp. 762–769 Schroder, J.N. 2005. Impact of mitral valve regurgitation evaluated by intraoperative

Shah, P.J. 2003. Survival after myocardial revascularization for ischemic cardiomyopathy: A

Simonsen, M. 2003. «Slow adoption of new device technologies seen in Europe». *American Health Consultants / Cardiovascular Device Update*, October, 2003, pp. 6 Soo, E.N. 2005. Eight years survival after partial left ventriculectomy (Case report). *Eur. J.* 

Stolf, N.A. 1998. Determinants of midterm outcome of partial left ventriculectomy in dilated

Yamaguchi, A. 2005. Left ventricular reconstruction benefits patients with dilated ischemic

Yamaguchi, H. 2000. Characteristics of myocardial 18F-fluorodeoxyglucose positron

emission computed tomography in dilated cardiomyopathy and ischemic

Cardiomyopathy. *Ann. Thorac. Surg*, Vol. 66, 1998, pp. 1585–1591

cardiomyopathy. *Ann. Thorac. Surg*. Vol. 79, 2005, pp. 456–461

cardiomyopathy. *Ann. Nucl. Med*., Vol. 14(1), 2000, pp. 33–38

No. 6, 2000, pp. 4–8

1997, pp. 3665–3671

1998, pp. 1801–1808

Vol. 116, 1998, pp. 566–577.

*Coll. Cardiol,* Vol. 37, 2001, pp. 474

*Morphology*, Vol. 122, No. 5, 2002, pp. 60–62

*Cardio-thorac. Surg*., Vol. 27, 2005, pp. 724–725

bypass grafting. *Circulation*, Vol. 112, 2005, pp. 1293–1298

61–67

110–114

1320–1327

2003, pp. 331-335

second half of the XX century: tendencies, possible reasons, perspective. *Cardiology*,

dilated cardiomyopathy: effects of conditioned muscle wrap. *Circulation,* Vol. 96,

patients with nonischemic dilated cardiomyopathy. *J. Am. Coll. Cardiol*. Vol. 32,

ventricular geometry and performance. *Eur. J. Cardio-thorac. Surg*., Vol. 19, 2001, pp.

contractile left ventricle: a simple finite element analysis. *J. Thorac. Cardiovasc. Surg,*

remodeling. *Bulletin of experimental biological medicine*, Vol. 135, No. 1, 2003, pp.

changes of right ventricle. *Bulletin of experimental biological medicine*, Vol. 136, No. 9,

support device downregulates stretch response proteins and improves sarcoplasmic reticulum calcium cycling in dogs with chronic heart failure. *J. Am.* 

transesophageal echocardiography on long-term outcomes after coronary artery

prospective ten-year follow-up study. *J. Thorac. Cardiovasc. Surg,* Vol. 5, 2003, pp.

Since the first cardiac surgical operations in the early '50s, the early and long-term outcomes have been dramatically improved also because of the refinement of technology regarding the extracorporeal circulation (ECC). It is recognized the ECC is associated with a systemic inflammatory response (SIRS), which is implicated in myocardial, renal, pulmonary and neurologic dysfunction. However, although the effects of ECC are very often subclinical, in some situations they can be responsible of worse outcome in the early post-operative period. In the early 1990s, many surgeons started to perform coronary revascularization without the use of ECC with the aim of strongly reducing the subclinical and clinical effects of the SIRS. Over the past fifteen years, the "off-pump" coronary artery bypass grafting (OPCABG) has demonstrated to have good results by reducing postoperative morbidity and mortality. On the other hand, the OPCABG presents some drawbacks such as the significant learning curve of the surgeon, the high rate of incomplete revascularization in dilated and hypokinetic heart due to very difficult exposure of obtuse coronary marginal branches and the lesser quality of the coronary anastomosis.

Over the past 10 years, concepts of miniaturized extracorporeal circulation (MECC) were developed with the aim of reducing the side effects of the standard ECC, strengthening the advantages of ECC and eliminate the limitations of OPCABG. In other words, the MECC joins the best of ECC with the best of "off-pump" surgery.
