Bilateral Extracorporeal Circulation (“Drew Technique”) for Coronary Artery Bypass Surgery using Patient’s Lung as Oxygenator

Abstract

The aim of this study was to determine: 1) whether a bilateral perfusion circuit (Drew technique) using the patient's own lung as the oxygenator is feasible for multi-vessel coronary artery bypass grafting; and 2) if the systemic inflammatory response to extracorporeal circulation differs compared to conventional cardiopulmonary bypass procedures. Twenty patients were enrolled in a randomized, controlled study. In the Drew group (n=10) bilateral perfusion was used. The other patients (n= 1 0) were operated on with conventional perfusion techniques and served as the control group. Pro- (interleukin-6) and anti-inflammatory (interleukin-10) mediators were measured before operation, during rewarming, 30 min, 2, 4, and 24 hours after extracorporeal circulation. The results show that: 1) multi-vessel coronary artery bypass grafting could be performed during 90 ± 8 min of bilateral cardiopulmonary bypass; 2) the concentration of the interleukin-6 was significantly lower in the Drew group at 2 hours (449 ± 82 versus 914 ± 152 pg/ml, p = 0.02), and 24 hours (146 ± 38 versus 424 ± 98 pg/ml, p = 0.02), after cardiopulmonary bypass. The Drew technique seems to be a promising method of extracorporeal circulation which: 1) can safely be used during routine coronary bypass grafting procedures; and 2) significantly reduces the systemic inflammatory response as compared to conventional extracorporeal circulation.