Nyawo Brian, Botha P, Pillay T, Clark S C, Tocewicz K, Forty J, Hamilton J R L, Hill P, Hasan A
Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Heart Surg Forum. 2008;11(1):E21-3. doi: 10.1532/HSF98.20061194.
Reoperative cardiac surgery is associated with substantial morbidity and mortality due to technical problems at sternal reentry, which can result in laceration of the right ventricle, innominate vein injury, or embolization from patent grafts. To minimize the risk associated with reentry, we adopted the method of assisted venous drainage in the cardiopulmonary bypass circuit with peripheral cannulation for cardiac reoperations. From March 1999 to May 2003, a series of 52 patients (38 males; mean age 48.7 years, range 4 months to 78 years) underwent cardiac reoperations performed with centrifugal pump venous-assisted cardiopulmonary bypass. EuroSCORE was 7.34 +/- 3.9 (range, 4-19). The reoperations were coronary artery bypass graft (25 patients), valve replacement/repair (18 patients), and complex pediatric procedures (11 patients). The studied adverse events were structural damage at reentry, mortality, blood loss, stroke, and hemolysis. Complications at sternotomy were damage to the innominate vein (1 patient) and aorta (1 patient) with blood loss of 625 and 225 mL, respectively. Four patients required intraaortic balloon pump or extracorporeal membrane oxygenation (n = 1) for hemodynamic support on weaning off cardiopulmonary bypass. Three patients died in the postoperative period. Our experience with centrifugal pump-assisted venous drainage in cardiac reoperations has shown excellent results, with reduced risk of damage to vital structures on sternal reentry. In cases in which structural damage did occur, blood loss was minimal.
再次心脏手术与胸骨再次切开时的技术问题导致的严重发病率和死亡率相关，这些技术问题可能会导致右心室撕裂、无名静脉损伤或来自通畅移植物的栓塞。为了将与再次切开相关的风险降至最低，我们在心肺转流回路中采用了辅助静脉引流方法，并进行外周插管用于心脏再次手术。从1999年3月至2003年5月，一系列52例患者（38例男性；平均年龄48.7岁，范围4个月至78岁）接受了使用离心泵静脉辅助心肺转流的心脏再次手术。欧洲心脏手术风险评估系统（EuroSCORE）为7.34±3.9（范围，4 - 19）。再次手术包括冠状动脉旁路移植术（25例患者）、瓣膜置换/修复术（18例患者）和复杂小儿手术（11例患者）。所研究的不良事件为再次切开时的结构损伤、死亡率、失血、中风和溶血。胸骨切开术的并发症包括无名静脉损伤（1例患者）和主动脉损伤（1例患者），失血量分别为625和225 mL。4例患者在脱离心肺转流时需要主动脉内球囊泵或体外膜肺氧合（n = 1）进行血流动力学支持。3例患者在术后死亡。我们在心脏再次手术中使用离心泵辅助静脉引流的经验显示了出色的结果，胸骨再次切开时重要结构受损的风险降低。在确实发生结构损伤的病例中，失血量最小。
