Miniaturized Extracorporeal Circulation (MECC) Versus Conventional Cardiopulmonary Bypass (CCPB): Clinical Outcomes and Cost Effectiveness Analysis

Abstract

The application of cardiopulmonary bypass (CPB) has been the focus of attention in cardiac surgery thereby allowing surgeries to be done on heart reconstructions and heart valve repair, repair of congenital defects and coronary bypass surgery. The classic CPB (CCPB) is reported to possess a number of limitations which comprise: hemodilution, systemic inflammatory responses, initiating of blood coagulation cascades and postoperative crises. These shortcomings prompted the development of Miniaturized Extracorporeal Circulation(MECC), which has fewer tubing and priming, less contact with air and blood and heparin-coated circuits. MECC has been reported to minimize transfusion, inflammatory activation, acute renal failure, atrial fibrillation, and intensive care unit (ICU) stay to improve overall patient recovery and better outcome. There is however no good research done on the economic attitudes of MECC adoption. The initial expenditures on specialized circuits and special infrastructure needs might be translated into downstream savings as saved transfusion, waste of time in the ICU, waste of complications and waste of hospital readmission. These possible advantages explain why costs-effectiveness studies (CEA) and cost-utility studies (CUA) are valuable in informing decision-making in resource rich, resource poor health care systems. Importantly, the review presents MECC and CCPB clinical outcome and economic considerations that need to be integrated with integrative evidence to inform policy, procurement, and clinical practice in value-based cardiac care.

Keywords: Cardiopulmonary Bypass (CPB), Conventional CPB (CCPB), Miniaturized Extracorporeal Circulation (MECC), Cardiac surgery, Hemodilution, Postoperative complications, Biocompatible circuits, Clinical outcomes, Cost-effectiveness analysis (CEA), Cost-utility analysis (CUA), Value-based cardiac care.