Pioneering MiECC in Pakistan: First Experience at Punjab Institute of Cardiology

Introduction Cardiopulmonary bypass (CPB) has long been a cornerstone of cardiac surgery. However, conventional CPB circuits are associated with a range of physiological disturbances including hemodilution, inflammatory response, and coagulopathy. Minimally Invasive Extracorporeal Circulation (MiECC) has emerged as an innovative solution to reduce the systemic impact of extracorporeal circulation. This article shares our first successful experience using the MiECC system at Punjab Institute of Cardiology (PIC), Lahore.

What is MiECC? MiECC is a closed, biologically inert, and compact perfusion circuit designed to minimize the adverse effects of traditional CPB. Key characteristics of MiECC include:

• Closed circuit with no blood-air interface
• Biocompatible coated surfaces
• Reduced priming volume
• Centrifugal pump
• Integrated cardioplegia system
• Reduced hemodilution and inflammatory activation (Salerno et al., 2018; Anastasiadis et al., 2016)

MiECC systems are categorized into Classes I to IV based on complexity and integration. Clinical studies suggest improved patient outcomes including reduced transfusion requirements, faster recovery, and lower complication rates (Anastasiadis et al., 2013).

Clinical Advantages

• Decreased systemic inflammatory response
• Lower need for blood transfusion
• Reduced priming volume
• Early extubation and shorter ICU stays
• Improved renal and neurological protection (Donat et al., 2017; Fromes et al., 2002)

Our First Experience at PIC On April 10, 2025, the PIC perfusion team conducted its first CABG procedure using a MiECC system. The case was carefully selected and planned in collaboration with our surgical and anesthetic teams. I received hands-on training in Switzerland under the guidance of Mr. Eric at the Burn Hospital, which proved instrumental in this successful implementation.

The patient tolerated the procedure well. Notably, the patient was extubated on the same day, and the postoperative course was uneventful. This outcome reflects the potential of MiECC in improving recovery trajectories in cardiac surgery patients.

Multidisciplinary Team Effort This success was a collective achievement involving cardiac surgeons, anesthetists, perfusionists, nurses, and OT technicians. Their commitment, coordination, and willingness to adapt to new technology were key to the smooth execution of this procedure.

Challenges and Considerations

• Initial setup and training
• Financial and resource limitations
• Resistance to change from conventional systems
• Need for careful case selection and monitoring

Future Directions The PIC perfusion team is optimistic about the wider application of MiECC in elective and complex cardiac surgeries. There is a need to invest in training, raise awareness among clinicians, and explore cost-effective strategies for implementation in resource-limited settings.

Conclusion Our first MiECC case marks a significant step forward in perfusion practice at PIC. The favorable outcome strengthens the case for adopting MiECC as a standard option in selected cardiac surgeries. We hope to lead by example and inspire more cardiac centers in Pakistan to explore this advancement.

References:

Anastasiadis K, Murkin JM, Antonitsis P, Bauer A, Ranucci M. (2016). Use of minimal invasive extracorporeal circulation in cardiac surgery: Principles, definitions and potential benefits.Perfusion, 31(6), 446–451. https://doi.org/10.1177/0267659116651831

Anastasiadis K, Antonitsis P, Deliopoulos A, et al. (2013). Minimal invasive extracorporeal circulation: A new era in perfusion. Hellenic Journal of Cardiology, 54(5), 357–363.

Donat U, Guenther T, Ziemer G. (2017). Minimized extracorporeal circulation: Clinical advantages and new applications. Seminars in Thoracic and Cardiovascular Surgery, 29(1), 92–97.

Fromes Y, Gaillard D, Ponzio O, et al. (2002). Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. European Journal of Cardio-Thoracic Surgery, 22(4), 527–533.

Salerno TA, Panos A, Panos AL. (2018). Mini-extracorporeal circulation systems: An update. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 13(3), 204–209.