| Autor: |
Likosky DS; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan., Baker RA; Cardiac Surgery Perfusion Services and Quality and Outcomes Unit, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia., Newland RF; Cardiac Surgery Perfusion Services and Quality and Outcomes Unit, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia., Paugh TA; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan., Dickinson TA; Division of Cardiovascular Perfusion, Mayo Clinic, Rochester, Minnesota., Fitzgerald D; Division of Cardiovascular Perfusion, The Medical University of South Carolina, Charleston, South Carolina., Goldberg JB; Westchester Medical Center, New York Medical College, Valhalla, New York., Mellas NB; Montefiore Heart Center, Bronx, New York., Merry AF; School of Medicine University of Auckland, Department of Anesthesia, Auckland City Hospital, Auckland, New Zealand., Myles PS; Department of Anaesthesia and Perioperative Medicine Alfred Hospital and Monash University, Melbourne, Australia., Paone G; Division of Cardiac Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Michigan., Shann KG; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts., Ottens J; Ashford Hospital, Adelaide, South Australia, Australia; and., Willcox TW; Green Lane Perfusion, Auckland City Hospital, Auckland, New Zealand. |
| Abstrakt: |
Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as "conventional," inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were "all-but-cannula" biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term "conventional bypass" may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients. |
