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对接受单纯冠状动脉搭桥手术的患者,比较美敦力静息心脏系统与传统体外循环的病例对照评估。

A case-controlled evaluation of the Medtronic Resting Heart System compared with conventional cardiopulmonary bypass in patients undergoing isolated coronary artery bypass surgery.

作者信息

Nozohoor Shahab, Johnsson Per, Scicluna Sara, Wallentin Per, Andell Elisabeth, Nilsson Johan

机构信息

Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital and Lund University, Lund, Sweden.

出版信息

Interact Cardiovasc Thorac Surg. 2012 May;14(5):599-604. doi: 10.1093/icvts/ivr158. Epub 2012 Jan 27.

Abstract

The Medtronic Resting Heart System (RHS) is a heparin-coated, closed perfusion circuit. Clinical results indicate less haemodilution and reduced complement activation, when compared with a traditional circuit leading to fewer postoperative blood transfusions. We evaluated the potential clinical benefits, including reduced transfusion requirements, when using the RHS compared with conventional cardiopulmonary bypass (cCPB). The study group (n = 330) consisted of patients undergoing isolated coronary artery bypass grafting (CABG) using the RHS system during 2005-2009, matched with a control group (n = 609) including patients operated for isolated CABG during 2002-2009, utilizing cCPB. Significantly fewer patients received peri- and postoperative blood transfusions in the RHS group (25 vs. 37%, P < 0.001; mean 1.0 ± 2.6 vs. mean 1.6 ± 2.9 units of packed red blood cells). The incidence of reoperations due to bleeding was low, RHS 2% (n = 8) vs. cCPB 5% (n = 29), with a trend towards no significant difference between groups (P = 0.079). The duration of mechanical ventilation was shorter (mean 7 ± 16 vs. 9 ± 12 h, P < 0.001) for patients in the RHS group. This study demonstrates that CABG performed with the RHS reduces the incidence and magnitude of allogenic blood transfusion and results in a satisfactory clinical outcome.

摘要

美敦力静息心脏系统(RHS)是一种肝素涂层的封闭式灌注回路。临床结果表明,与传统回路相比,其血液稀释较少,补体激活减少,从而减少了术后输血次数。我们评估了使用RHS与传统体外循环(cCPB)相比的潜在临床益处,包括减少输血需求。研究组(n = 330)由2005年至2009年期间使用RHS系统进行单纯冠状动脉旁路移植术(CABG)的患者组成,与对照组(n = 609)匹配,对照组包括2002年至2009年期间使用cCPB进行单纯CABG手术的患者。RHS组围手术期和术后接受输血的患者明显较少(25%对37%,P < 0.001;平均1.0±2.6单位对平均1.6±2.9单位浓缩红细胞)。因出血而再次手术的发生率较低,RHS组为2%(n = 8),cCPB组为5%(n = 29),两组之间无显著差异的趋势(P = 0.079)。RHS组患者的机械通气时间较短(平均7±16小时对9±12小时,P < 0.001)。这项研究表明,使用RHS进行CABG可降低异体输血的发生率和程度,并产生令人满意的临床结果。

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