***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: 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 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 a low priming circuit without blood-air interface . Technical feasibility , in particular the potential entry of air in the circuit , and clinical results were prospect ively evaluated . RESULTS Demographic characteristics and surgical data were similar in both groups . Patients in the study group showed reduced chest tube drainage ( 217 + /- 62 mL vs 420 + /- 219 mL , p < 0.05 ) and blood transfusion requirements ( 5.1 % vs 43.4 % , p < 0.02 ) compared with patients in the control group . Moreover , the study group showed significantly higher time course of hematocrit at all time points during the operation and longer hospital stay ( p < 0.02 ) than the control group ; similarly , in the study group patients ' platelet count in intensive care unit admission was significantly higher than the control group ( 140 + /- 29 x 10(9)/L vs 119 + /- 37 x 10(9)/L , p < 0.05 ) . Peak postoperative troponin C release was significantly lower in the study group ( 4.74 + /- 2.82 vs 8.43 + /- 6.25 ng/dL , p < 0.033 ) . One patient undergoing the MECC system operation showed a major neurologic event on postoperative day four , which was probably secondary to severe aortic calcification . CONCLUSIONS The MECC system is suitable for aortic valve replacement and provides better clinical results than st and ard cardiopulmonary bypass as regards blood transfusion requirements , platelets consumption , and myocardial damage BACKGROUND Minimized extracorporeal circulation is intended to reduce the negative effects associated with cardiopulmonary bypass . This prospect i ve study was performed to evaluate whether minimized extracorporeal circulation has a clinical benefit for coronary artery surgery patients compared to st and ard extracorporeal circulation . METHODS Sixty patients were r and omized into two study groups : 30 patients underwent coronary artery bypass grafting using minimized extracorporeal circulation and 30 patients were operated using st and ard extracorporeal circulation .  Baseline characteristics , intraoperative details , postoperative data , perioperative blood chemistry determinations of hematocrit , platelets , muscle-brain fraction of the creatine kinase , cardiac troponin T and colloid osmotic pressure as measurements of intrathoracic blood volume index and extravascular lung water index were compared . RESULTS Baseline characteristics and intraoperative details of both groups were similar . Patients who underwent minimized extracorporeal circulation showed more short-term dependency on norepinephrine ( P < 0.01 ) . Their maximal postoperative muscle-brain fraction of the creatine kinase was lower ( P < 0.05 ) and their hematocrit on arrival in the intensive care unit was higher ( P < 0.01 ) . No other significant differences were found . In both collectives , values for hematocrit ( P < 0.001 ) , platelets ( P < 0.001 ) , colloid osmotic pressure ( P < 0.001 ) and intrathoracic blood volume index ( P < 0.05 ) decreased , while the extravascular lung water index did not change significantly during cardiopulmonary bypass . CONCLUSIONS A clinical advantage of minimized over st and ard extracorporeal circulation was not found . Furthermore , a higher number of patients in the minimized extracorporeal circulation group required postoperative norepinephrine infusions for hemodynamic stabilization . In summary , the presumed superiority of minimized extracorporeal circulation for coronary artery bypass grafting in st and ard patients could not be confirmed The intention of minimal extracorporeal circulation ( MECC ) is to reduce priming volume and minimize contact of blood with polymers and air in a closed system . In contrast to conventional extracorporeal circulation ( ECC ) , a venous reservoir is missing . Thus , air trapping is limited and avoidance of bubble embolism is a major concern . This study investigates microbubbles ( MBB ) number and size in the venous and arterial lines of ECC and MECC compared to the number of microembolic signals ( MES ) in the right and left middle cerebral artery ( MCA ) . Twenty patients undergoing coronary surgery were operated either with conventional ECC ( cardiotomy reservoir , Rotaflow pump , Quadrox oxygenator , Quart filter ) or MECC ( Quart filter , Rotaflow pump , Quadrox oxygenator ) .  Number and size of MBB were monitored in the venous and arterial lines with an ultrasound Doppler system . MES in right and left MCAs were measured by transcranial Doppler ( TCD ) monitoring . Patients undergoing MECC had additional sealing of the venous cannula by a ligature at the site of its insertion into the right atrium . There were no significant differences between groups with respect to age , X-clamping , bypass time and number of distal anastomoses . The number of MES and MBB in the arterial line was comparable between the groups . On the venous side , MECC-perfusion shows a significantly lower number of MBB . This could be explained with the additional sealing of the venous cannula . Furthermore , our data indicate that the MBB-volume reaching the pump will also appear in the arterial outflow and into the patient ’s MCA . For this reason , the avoidance of air contamination is a major concern for surgeons , anaesthesiologists and perfusionists A compact cardiopulmonary bypass ( CPB ) utilized by closed circuit system with minimized priming volume can be a solution to reduce adverse effects of CPB , and the Resting Heart System ( RHS ; Medtronic , Inc , Minneapolis , MN , USA ) is the newest one on the market . We performed  CABG with RHS in 10 patients , and report here our preliminary experiences with RHS in comparison with conventional CPB .  Twenty patients who underwent isolated CABG were r and omized into two groups ;  RHS group ( n=10 ) with the use of RHS and Conventional group ( n=10 ) with the use of a conventional CPB . There were no significant differences of preoperative patient characteristics in both groups . The mean number of grafts was 2.7+/-0.6 and 2.7+/-0.8 ( P=0.38 ) , the mean aortic clamp was 32+/-11 and 35+/-11 min ( P=0.35 ) , and CPB times were 68+/-25 and 72+/-24 min ( P=0.82 ) in RHS and Conventional group , respectively . All patients but one had no complications and survived in both groups . One patient in RHS group died suddenly on the 5th postoperative day after uneventful postoperative course . Postoperative leukocyte count at 6 h after the operation and value of the C-reactive protein were 11200+/-2310 and 13300+/-3990/mm(3 ) ( P=0.10 ) and 44.4+/-9.7 and 65.3+/-18.5 mg/l ( P=0.045 ) in RHS and Conventional group , respectively . CABG operations could be safely performed using the RHS with a comfort level similar to st and ard CPB Background — We aim ed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system ( MECC ) compared with off-pump coronary revascularization ( OPCABG ) . Methods and Results — In a prospect i ve r and omized study , 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG .  End points were ( 1 ) circulating markers of inflammation and organ injury , ( 2 ) operative results , and 
    Output:
    
Miniaturized cardiopulmonary bypass has beneficial effects result ing in decreased transfusion rate and cardiac and neurologic damage