(BQ) Part 2 book “Principles of miniaturized extracorporeal circulation” has contents: Surgical considerations, anaesthetic management, clinical outcome after surgery with MECC Versus CECC versus OPCAB, MECC in valve surgery, future perspectives, and other contents. | 5 Surgical Considerations Minimized cardiopulmonary bypass (CPB) systems represent a promising technology in heart surgery. The results from series of patients being operated on minimized extracorporeal circulation (MECC) are impressive, and the net outcome from their use is a stable intraoperative and postoperative course for the patient and a significantly reduced morbidity as well as lower perioperative mortality [1]. However, use of MECC demands a close multidisciplinary effort from the surgical team (surgeon, anaesthesiologist, perfusionist) comprising delicate and focused manoeuvres intraoperatively as well as a high level of cooperation from the team. Hence, a learning curve for obtaining the best performance is necessary [2]. Remadi et al. were among the first surgical teams who used the systems and first reported that the application of MECC requires the team to undergo a considerable learning curve [3]. As a result the report of a reduction in intraoperative blood loss after 50 cases with MECC was explained by this learning curve. Overall, teaching MECC has to be focused in the proper intraoperative setting, the consideration of tips and tricks, pitfalls, and drawbacks of the technique as well as the manoeuvres which are necessary from each one of the surgical team so as to perform a safe and stable procedure. Regarding surgical strategy, in the set-up the MECC system has to be placed always as close as possible to the right side of the patient’s head and not parallel to the patient like the conventional extracorporeal circulation (CECC). Short tubing is of great importance for system’s qualities (Fig. ). Standard cannulation technique for connecting the system to the patient with heparinized cannulae is used. Special care must be taken in managing any active drainage perfusion system, such as MECC, during cannulation procedure. Hence, ‘airtight’ cannulation site is secured with two silk ties around the tourniquets and cannula in order to .
