Ranucci Marco, Isgrò Giuseppe
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico S, Donato, Via Morandi 30, San Donato Milanese (Milan) - 20097, Italy.
Crit Care. 2007;11(2):R45. doi: 10.1186/cc5777.
Many innovative cardiopulmonary bypass (CPB) systems have recently been proposed by the industry. With few differences, they all share a philosophy based on priming volume reduction, closed circuit with separation of the surgical field suction, centrifugal pump, and biocompatible circuit and oxygenator. These minimally invasive CPB (MICPB) systems are intended to limit the deleterious effects of a conventional CPB. However, no evidence exists with respect to their effectiveness in improving the postoperative outcome in a large population of patients. This study aimed to verify the clinical impact of an MICPB in a large population of patients undergoing coronary artery revascularization.
We conducted a retrospective analysis of 1,663 patients treated with an MICPB. The control group (conventional CPB) was extracted from a series of 2,877 patients according to a propensity score analysis.
Patients receiving an MICPB had a shorter intensive care unit (ICU) stay, had lower peak postoperative serum creatinine and bilirubin levels, and suffered less postoperative blood loss. Within a multivariable model, MICPB is independently associated with lower rates of atrial fibrillation (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69 to 0.99) and ventricular arrhythmias (OR 0.45, 95% CI 0.28 to 0.73) and with higher rates of early discharge from the ICU (OR 1.31, 95% CI 1.06 to 1.6) and from the hospital (OR 1.46, 95% CI 1.18 to 1.8). Hospital mortality did not differ between groups.
MICPBs are associated with reduced morbidity. However, these results will need to be confirmed in a large, prospective, randomized, controlled trial.
近年来，业界提出了许多创新的体外循环（CPB）系统。这些系统虽存在细微差异，但都秉持着减少预充量的理念，采用封闭循环，将手术野吸引、离心泵以及生物相容性回路和氧合器分开。这些微创体外循环（MICPB）系统旨在限制传统体外循环的有害影响。然而，尚无证据表明其在大量患者中对改善术后结局的有效性。本研究旨在验证MICPB对大量接受冠状动脉血运重建患者的临床影响。
我们对1663例接受MICPB治疗的患者进行了回顾性分析。根据倾向评分分析，从一系列2877例患者中提取对照组（传统CPB）。
接受MICPB的患者重症监护病房（ICU）住院时间较短，术后血清肌酐和胆红素峰值水平较低，术后失血量较少。在多变量模型中，MICPB与较低的房颤发生率（优势比[OR]0.83，95%置信区间[CI]0.69至0.99）和室性心律失常发生率（OR 0.45，95%CI 0.28至0.73）以及较高的ICU早期出院率（OR 1.31，95%CI 1.06至1.6）和医院早期出院率（OR 1.46，95%CI 1.18至1.8）独立相关。两组间医院死亡率无差异。
MICPB与发病率降低相关。然而，这些结果需要在大型、前瞻性、随机对照试验中得到证实。
