***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : We examined intraoperative microembolic signals ( GME ) , inflammatory response , hemolysis , perioperative regional cerebral oxygen saturation ( rSO2 ) , myocardial protection and desorbed protein amount on oxygenator fibers in high-risk patients undergoing coronary revascularization ( CABG ) with minimized and conventional cardiopulmonary bypass ( CPB ) . Methods : Over a ten-month period , 40 Euroscore 6 + patients undergoing CABG  were prospect ively r and omized to one of the two perfusion protocol s ( N=20 ) : Group 1 : minimized extracorporeal circuits ( Mini-CPB ) ( ROCsafe MPC , Terumo , Ann Arbor , MI , USA ) and Group 2 : conventional extracorporeal circuits ( CECC ) ( Capiox SX18 , Terumo , USA ) . Serum creatinine kinase-MB ( CKMB ) , free hemoglobin , interleukin-6 ( IL-6 ) and C3a levels were measured . Blood sample s were collected at T1 : following induction of anesthesia ; T2 : thromboelastography control ; T3:15 min after commencement of CPB ; T4 : before cessation of CPB ; T5 : 15 min after protamine reversal and T6 : ICU . Results : Serum IL-6 levels were significantly lower in the Mini-CPB group at T4 and T5 and C3a levels were significantly less in the Mini-CPB group at T3 , T4 and T5 vs. CECC ( p<0.01 ) . CKMB levels in coronary sinus blood demonstrated well preserved myocardium in the Mini-CPB group . Percentage expression of neutrophil CD11b/CD18 levels were significantly lower in the Mini-CPB group at T4 and T5 ( p<0.05 ) . There were no significant differences in air h and ling characteristics or free plasma hemoglobin levels in either circuit . rSO2 measurements were significantly better at T3 and T4 in the Mini-CPB vs. CECC ( p<0.05 ) and always higher in the Mini-CPB during follow-up . Blood protein adsorption analysis of oxygenator membranes demonstrated a significantly increased amount of microalbumin on CECC fibers ( p<0.05 ) . Conclusion : Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air h and ling , attenuated inflammatory response and hemodilution , with a better clinical outcome in patients undergoing high-risk CABG In this prospect i ve cohort study we addressed the clinical impact of a reduced anticoagulation protocol on the hospital outcome of patients undergoing coronary revascularization with cardiopulmonary bypass . 364 consecutive low to moderate risk patients scheduled for elective isolated coronary operations were admitted to the study . 184 patients ( Control Group ) received conventional open circuits and full systemic anticoagulation ( target activated clotting time 480 seconds ) ; 180 patients ( Intraoperative ECMO group ) received closed , phosphorylcholine coated circuits and a reduced systemic heparin dose ( target activated clotting time 320 seconds ) . Patients of the Intraoperative ECMO group had less requirement for allogeneic blood products ( odds ratio 0.55 , 95 % confidence interval 0.34–0.92 , p= 0.02 ) , a significant containment of blood loss ( 374 ± 278 mL vs. 463 ± 321 mL in Control group , p= 0.005 ) a lower postoperative peak serum creatinine levels ( 1.19 ± 0.48 mg/dL vs. 1.41 ± 0.94 mg/dL in Control group , p= 0.048 ) , and a significant lower rate of severe morbidity ( odds ratio 0.27 , 95 % confidence interval 0.09–0.81 , p= 0.02 ) . A reduction of systemic anticoagulation is feasible with a non-heparin-bonded , closed biocompatible circuit , and results in a significant improvement of the outcome of low to moderate risk coronary patients PURPOSE Inflammation and coagulation disturbances are common consequences of  cardiopulmonary bypass ( CPB ) . Recently , miniaturized closed CPB circuits without cardiotomy suction and venous reservoir have been proposed to reduce complication rates . We compared outcomes with conventional ( CCPB ) and miniaturized cardiopulmonary bypass ( MCPB ) after coronary artery bypass operations ( CABG ) with respect to inflammation and coagulation . DESCRIPTION Thirty patients ( 23 % female ; aged 67.9 + /- 9.0 years ) were prospect ively r and omly assigned to undergo isolated CABG with CCPB or MCPB . Conventional CPB had a pump prime of 1 , 600 mL. Miniaturized CPB consisted of a centrifugal pump , arterial filter , heparinized tubing , and oxygenator with a priming volume of 800 mL. Shed blood was removed by a cell-saving device and reinfused . Measurements included interleukin (IL)-2 receptor , IL-6 , IL-10 , tumor necrosis factor receptor 55 and 75 , C reactive protein , leukocyte differentiation , d-dimers , fibrinogen , and thrombocytes at six time points . EVALUATION In both groups no major complication occurred . However , two dangerous air leaks occurred in the closed MCPB circuit , demonstrating the narrow safety margins . Operative h and ling was also more difficult owing to limitations in venting and fluid management . International normalized ratio ( p = 0.03 ) and antithrombin III ( p = 0.04 ) levels were elevated during CPB in the CCPB group , most likely owing to differences of the intraoperative anticoagulation management . Repeated measures analysis revealed that not a single parameter of inflammation or clinical outcome showed significant differences among groups . CONCLUSIONS Use of a MCPB affected inflammation and coagulation variables only marginally and did not lead to clinical relevant changes as assessed by blood loss , need for blood products , and intensive care unit and clinical stays . However , safety margins for volume loss , air emboli , and weaning from CPB decrease , because of the closed MCPB circuit Objectives . Cardiopulmonary bypass ( CPB ) is known to cause the systemic inflammatory reaction after cardiac surgery . New coated and closed loop circuit systems may reduce this inflammation response and improve the surgical outcome . This study was design ed to evaluate the safety and efficacy of the mini-extracorporeal circulation system ( ECC.O ) in CABG patients . Design . Forty patients undergoing elective coronary surgery were r and omized into two groups , the ECC.O group and the st and ard CPB group . Routine hemodynamic monitoring and biochemical measurements were registered according to the hospital practice . Results . The clinical outcome of the patients was similar in both groups . There were no significant differences between the groups in the duration of intubation following surgery , the length of intensive care unit-stay or the total hospital stay . The haemoglobin level was significantly higher ( p=0.0069 ) during and after the perfusion in the ECC.O group . Conclusions . The ECC.O system can be safely used in CABG patients and it maintains haemoglobin level better than conventional CPB OBJECTIVE Coronary artery bypass grafting with cardiopulmonary bypass carries a risk for neurologic complications because of cerebral hypoperfusion and microembolization . The basic goals of a novel closed minimized extracorporeal circulation are to prevent excessive hemodilution and to avoid blood-air interface . The aim of this prospect i ve r and omized study was to determine the effect of using the minimized extracorporeal circulation system compared with open conventional extracorporeal circulation on cerebral tissue oxygenation and microembolization . METHODS Forty patients undergoing coronary artery bypass grafting ( 20 in each group ) were continuously monitored for changes in cerebral oxygenated hemoglobin and tissue oxygenation index by using near-infrared spectroscopy . Total microembolic count and gaseous embolic count in both median cerebral arteries were monitored with multifrequency transcranial Doppler instrumentation . RESULTS In the conventional extracorporeal circulation group there was a highly significant reduction in both cerebral oxygenated hemoglobin and tissue oxygenation index from the start to the end of cardiopulmonary bypass ( P < .01 ) . The rate of decrease in cerebral oxygenated hemoglobin after aortic cannulation was faster in the conventional extracorporeal circulation group ( F test = 9.03 , P < .001 ) . No significant changes with respect to cerebral oxygenated hemoglobin or tissue oxygenation index occurred in the minimized extracorporeal circulation group , except at the beginning of rewarming ( P < .01 ) . Total embolic count , as well as gaseous embolic count , in the left and right median cerebral arteries was significantly lower in the minimized extracorporeal circulation group ( all P < .05 ) . Postoperative bleeding was greater ( P < .05 ) and the transfusion rate was higher ( P < .05 ) in the conventional extracorporeal circulation group . CONCLUSIONS Use of closed minimized cardiopulmonary bypass compared with conventional open cardiopulmonary bypass preserves cerebral tissue oxygenation and reduces cerebral microembolization Neutrophil gelatinase-associated lipocalin ( NGAL ) has been implicated as an early predictive urinary biomarker of ischemic acute kidney injury ( AKI ) . The aim of this study was to compare the effects of miniaturized cardiopulmonary bypass system ( MCPB ) vs. st and ard cardiopulmonary bypass system ( SCPB ) system on kidney tissue in patients undergoing myocardial revascularization using urinary NGAL levels as an early marker for renal injury . Sixty consecutive patients who underwent myocardial revascularization were studied prospect ively . An SCPB was used in 30 patients ( group A ) and MCPB was used in 30 patients ( group B ) . The SCPB group but not the MCPB group showed a significant NGAL concentration increase from preoperative during the 1st postoperative day ( 169.0+/-163.6 ng/ml in the SCPB group vs. 94.1+/-99.4 ng/ml in the MCPB group , P<0.05 , respectively ) . Two patients in the SCPB group developed AKI and underwent renal replacement therapy ; no patient in MCPB developed AKI . The MCPB system is safe in routine clinical use . Kidney function is better protected during MCPB as demonstrated by NGAL levels . NGAL represents an early biomarker of renal failure in patients undergoing cardiac surgery and the valuation of its concentration can aid in medical decision-making OBJECTIVE Minimal extracorporeal circulation ( mini-ECC ) is a new technology , consisting of a centrifugal pump , an oxygenator , and a modified suction system . The main advantage of mini-ECC is the reduction of tubing length ( reduction of the priming volume ) . Additional beneficial effects are a decrease of coagulation cascade and a reduction of blood transfusion in patients undergoing coronary artery bypass grafting ( CABG ) surgery . We compared the intraoperative and early postoperative myocardial damage and outcome of patients who underwent CABG surgery with conventional cardiopulmonary bypass ( CPB ) or mini-ECC .  METHODS One hundred and thirty-six consecutive patients who underwent isolated CABG surgery at our institution were prospect ively studied . Fifty-four patients ( 39.7 % ) were operated with mini-ECC .  Patient characteristics were similar in both groups . The most interesting intraoperative details as well as in-hospital outcome were assessed . RESULTS There was no difference in mortality between the two groups . Cross-clamping time was similar in both groups ( p = 0.07 ) . Defibrillation was required in one patient in the mini-ECC group ( 1.9 % ) and in 38 patients ( 46.3 % ) in the CPB group ( p < 0.001 ) . In the mini-ECC group , the requirement of inotropic support and incidence of atrial fibrillation was significantly lower than in the CPB group . Postoperative creatine kinase isoenzyme MB ( CK-MB ) and cardiac Troponin I ( cTnI ) were significantly lower in the mini-ECC group ( p < 0.05 ) . Duration of ventilation , length of stay in the intensive care unit and total hospitalization time were significantly shorter in patients operated with mini-ECC ( p < 0.05 ) . CONCLUSION Mini-ECC is a safe procedure and is followed by a diminished release of CK-MB and cTnI than after CPB . Postoperative recovery is accelerated following mini-ECC and there is a significantly lower incidence of postoperative atrial fibrillation BACKGROUND The purpose of this study was to evaluate the safety and clinical results of aortic valve replacement performed with minimally invasive closed circuit extracorporeal circulation technique ( MECC system ) versus st and ard cardiopulmonary bypass . METHODS Forty consecutive patients undergoing isolated aortic valve replacement at a single institution were r and omly assigned to either miniaturized closed circuit cardiopulmonary bypass with the Maquet-Cardiopulmonary ( Rastatt , Germany ) minimal extracorporeal circulation ( MECC ) system ( study group B , n = 17 ) or st and ard cardiopulmonary bypass ( control group A , n = 23 ) . The MECC system is 
    Output:
    
CONCLUSIONS Use of MECC in heart surgery result ed in improved short-term outcome as reflected by reduced mortality and morbidity compared with conventional extracorporeal circulation