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J Thorac Cardiovasc Surg 2004;128:436-441
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: A randomized prospective trial

J.P. Remadi, MDa,*, Z. Rakotoarivello, MDa, P. Marticho, MDa, F. Trojette, MDa, A. Benamar, MDa, H. Poulain, MDa, C. Tribouilloy, PhDa

a Cardiovascular Surgery Unit and Anaesthesiology Department, South Hospital, Amiens, France

Received for publication October 9, 2003; revisions received January 4, 2004; accepted for publication January 27, 2004.

* Address for reprints: J. P. Remadi, MD, Cardiovascular and Thoracic Surgery Unit, South Hospital, 80054 Amiens Cedex 1, France
remadi.jean-paul{at}chu-amiens.fr

BACKGROUND: We prospectively evaluated a newly introduced minimal extracorporeal circulation system (Jostra MECC System; Jostra AG, Hirrlingen, Germany) for aortic valve surgery.

METHOD: In a prospective, randomized study, 100 patients underwent aortic valve replacement either with standard cardiopulmonary bypass (n = 50, group B) or with the MECC System (n = 50, group B). The myocardial protection and the left vent were identical for the two groups. The intrapericardial suction device was never used (only the cell salvage device was used) to reduce the air-blood contact area.

RESULTS: No significant differences were noted in patient characteristics and operative data between groups. Operative mortality (<30 days) was 2% for group A and 4% for group B (difference not significant). From the preoperative period to the postoperative period, the increase in C-reactive protein was significantly higher for group B (P < .001). The postoperative troponin I level was significantly lower in group A (mean 4.65 ± 2.9 µg/L at 24 hours) than in group B (8.2 ± 4.4 µg/L, P < .03). On the other hand, the MECC System was associated with platelet preservation. Renal function was better preserved and the neurologic event rate was significantly lower for the MECC group (P < .02).

CONCLUSION: The MECC System is safe and allows aortic valve replacement under the most favorable conditions. The system is more biocompatible than standard cardiopulmonary bypass and provides a good postoperative biologic profile and good clinical results, particularly for high-risk patients.




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