Minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement
| Autor: | Alessandro Verzini, Alessandro Castiglioni, Federico Pappalardo, Ottavio Alfieri, Alberto Zangrillo, Nicola Colangelo, Lucia Torracca |
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| Přispěvatelé: | Castiglioni, A, Verzini, A, Pappalardo, Federico, Colangelo, N, Torracca, L, Zangrillo, Alberto, Alfieri, Ottavio |
| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Thorax Aortic valve Extracorporeal Circulation medicine.medical_specialty Time Factors Blood transfusion medicine.medical_treatment Heart Valve Diseases Hematocrit law.invention Intraoperative Period Postoperative Complications Aortic valve replacement law medicine Cardiopulmonary bypass Humans Minimally Invasive Surgical Procedures Blood Transfusion Postoperative Period Heart valve Aged Heart Valve Prosthesis Implantation medicine.diagnostic_test Platelet Count business.industry Extracorporeal circulation Length of Stay Middle Aged medicine.disease Surgery Intensive Care Units medicine.anatomical_structure Aortic Valve Chest Tubes Anesthesia Drainage Female Nervous System Diseases Troponin C Cardiology and Cardiovascular Medicine business |
| Popis: | 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 standard cardiopulmonary bypass.METHODS: Forty consecutive patients undergoing isolated aortic valve replacement at a single institution were randomly 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 standard 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 prospectively 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 standard cardiopulmonary bypass as regards blood transfusion requirements, platelets consumption, and myocardial damage. |
| Databáze: | OpenAIRE |
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