Stalder Mario, Gygax Erich, Immer Franz F, Englberger Lars, Tevaearai Hendrik, Carrel Thierry P
Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland.
Heart Surg Forum. 2007;10(3):E235-8. doi: 10.1532/HSF98.20070703.
The standard heart-lung machine is a major trigger of systemic inflammatory response and the morbidity attributed to conventional extracorporeal circulation (CECC) is still significant. Reduction of blood-artificial surface contact and reduction of priming volume are principal aims in minimized extracorporeal circulation (MECC) cardiopulmonary bypass systems. The aim of this paper is to give an overview of the literature and to present our experience with the MECC-smart suction system.
At our institution, 1799 patients underwent isolated coronary artery bypass grafting (CABG) surgery, 1372 with a MECC-smart suction system and 427 with CECC. All in-hospital data were assessed and the results were compared between the 2 groups. Patient characteristics and the distribution of EuroSCORE risk profile in our collective were similar between both groups. Average age in the MECC collective was 67.5 +/- 11.4 years and average EuroSCORE was 5.0 +/- 1.5. Average number of distal anastomoses was similar to the average number encountered in patients undergoing CABG surgery with CECC (3.3 +/- 1.0 for MECC versus 3.2 +/- 1.1 for CECC; P = ns). Myocardial protection is superior in MECC patients with lower postoperative maximal cTnI values (11.0 +/- 10.8 micromol/L for MECC versus 24.7 +/- 25.3 micromol/L for CECC; P < .05). Postoperative recovery was faster in patients operated on with the MECC-smart suction system and discharge from the hospital was earlier than for CECC patients (7.4 +/- 1.9 days for MECC versus 8.8 +/- 3.8 days for CECC; P < .05).
The MECC-smart suction system is a safe perfusion technique for CABG surgery. In patients operated on with this system, the clinical outcome seems to be better than in patients operated on with CECC. This promising and less damaging perfusion technology has the potential to replace CECC systems in CABG surgery.
标准心肺机是全身炎症反应的主要触发因素，传统体外循环（CECC）所致的发病率仍然很高。减少血液与人工表面的接触以及减少预充量是微创体外循环（MECC）心肺转流系统的主要目标。本文旨在对相关文献进行综述，并介绍我们使用MECC智能吸引系统的经验。
在我们机构，1799例患者接受了单纯冠状动脉旁路移植术（CABG），其中1372例使用MECC智能吸引系统，427例使用CECC。评估了所有住院数据，并对两组结果进行了比较。两组患者的特征以及欧洲心脏手术风险评估系统（EuroSCORE）风险概况分布相似。MECC组患者的平均年龄为67.5±11.4岁，平均EuroSCORE为5.0±1.5。远端吻合的平均数量与接受CECC的CABG手术患者所遇到的平均数量相似（MECC为3.3±1.0，CECC为3.2±1.1；P=无显著性差异）。MECC患者的心肌保护更好，术后最大肌钙蛋白I（cTnI）值更低（MECC为11.0±10.8微摩尔/升，CECC为24.7±25.3微摩尔/升；P<.05）。使用MECC智能吸引系统进行手术的患者术后恢复更快，出院时间也比CECC患者更早（MECC为7.4±1.9天，CECC为8.8±3.8天；P<.05）。
MECC智能吸引系统是一种用于CABG手术的安全灌注技术。使用该系统进行手术的患者，临床结局似乎优于使用CECC的患者。这种有前景且损伤较小的灌注技术有可能在CABG手术中取代CECC系统。
