Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery

Perfusion (United Kingdom) - Tập 26 Số 6 - Trang 479-486 - 2011
Riikka Rimpiläinen1, Nina Hautala2, J.K. Koskenkari1, Jussi Rimpiläinen3, P P Ohtonen1,3, Pirjo Mustonen4, H-M Surcel5, E-R Savolainen6, Martti Mosorin2, TI Ala-Kokko1, Tatu Juvonen3
1Departments of Anesthesiology and Surgery, Division of Anesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland
2Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
3Division of Cardiothoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland
4The Finnish Red Cross Blood Service, Oulu, Finland
5National Institute for Health and Welfare, Oulu, Finland
6Department of Clinical Chemistry, Oulu University Hospital, Oulu, Finland

Tóm tắt

Objectives: Minimized cardiopulmonary bypass (MCPB) circuits have been shown to reduce cerebral and retinal microembolisation during coronary artery bypass graft (CABG) surgery compared to conventional CPB (CCPB) circuits. Our aim was to evaluate whether the reduction of microembolisation is sustained in aortic valve surgery, as well as to evaluate the effects of MCPB on inflammatory, endothelial, and platelet activation markers. Material and methods: Patients were randomized to undergo aortic valve replacement (AVR), with or without CABG, with MPCB (n=20) or CCPB (n=20). After anaesthesia induction and termination of CPB, standardized digital retinal fluorescein angiography images were obtained on both eyes and analyzed in a blinded fashion. Blood samples were collected at eight time points until the third postoperative day. Results: Fewer patients in the MCPB group showed evidence of microembolic perfusion defects on postperfusion retinal fluorescein angiographs compared to the CCPB group (37% vs. 63%, absolute difference 26%, 95% CI -5% -51%, P = 0.194). Polymorphonuclear leukocyte (PMN) elastase and von Willebrand factor release were statistically significantly reduced in the MCPB group, but there were no significant differences in other markers of inflammation, coagulation or endothelial activation. A significantly higher three-fold increase in the amount of shed blood was collected to the cell saver with a higher rate of intraoperative platelet transfusion in the MCPB group compared to CCPB. Conclusions: The use of MCPB was associated statistically insignificantly with less retinal microemboli compared to CCPB. MCPB was complicated by excess bleeding and need for transfusion. The feasibility of MCPB techniques in valve surgery requires further studies.

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Perfusion (United Kingdom)

Tập 26 Số 6

479-486

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