Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea.
Artif Organs. 2014 Jan;38(1):78-87. doi: 10.1111/aor.12241. Epub 2013 Dec 23.
Reducing the cardiopulmonary bypass (CPB) priming volume in congenital cardiac surgery is important because it is associated with fewer transfusions. This retrospective study was designed to compare safety and transfusion volumes between the mini-volume priming (MP) and conventional priming (CP) methods. Between 2007 and 2012, congenital heart surgery using CPB was performed on 480 infants (≤5 kg): the MP method was used in 331 infants (MP group, 69.0%), and the CP method was used in 149 infants (CP group, 31.0%). In the MP group, narrow-caliber (3/16″) tubing was used, and the pump heads were vertically aligned to shorten the tubing lengths. The smallest possible oxygenators and hemofilters were used, and vacuum drainage was applied. Ultrafiltration was vigorously applied during CPB to avoid excessive hemodilution. The mean age and body weight of the patients were 48 ± 41 (0-306) days and 3.8 ± 0.8 (1.3-5.0) kg, respectively. The total priming and transfusion volumes during CPB were lower in the MP group than in the CP group (141 ± 24 mL vs. 292 ± 50 mL, P < 0.001, and 82 ± 40 mL vs. 162 ± 82 mL, P < 0.001, respectively). In the MP group, the smallest priming volume was 110 mL. However, there was no significant difference in the lowest hematocrit level during CPB between the two groups (22 ± 3% vs. 22 ± 3%, P = 0.724). The incidence of postoperative neurological complications was not significantly different between the MP and CP groups (1.8% vs. 2.7%, P = 0.509). After adjustment for the Risk Adjustment for Congenital Heart Surgery category, body surface area, and age, MP was not an independent risk factor of postoperative neurological complications or early mortality (P = 0.213 and P = 0.467, respectively). The MP method reduced the priming volume to approximately 140 mL without increasing the risk of morbidity or mortality in infants ≤5 kg. The total transfusion volume during CPB was reduced by 50% without compromising hematocrit levels. We recommend the use of mini-volume priming, which is a safe and effective method for reducing transfusion volumes.
在先天性心脏手术中减少心肺转流（CPB）预充量很重要，因为这与减少输血有关。本回顾性研究旨在比较小容量预充（MP）和传统预充（CP）方法的安全性和输血量。2007 年至 2012 年，对 480 名（≤5kg）婴儿进行 CPB 先天性心脏手术：331 名婴儿采用 MP 方法（MP 组，69.0%），149 名婴儿采用 CP 方法（CP 组，31.0%）。在 MP 组中，使用了窄口径（3/16"）管，并且将泵头垂直对齐以缩短管长。使用尽可能小的氧合器和血液滤器，并应用真空引流。CPB 期间积极超滤以避免过度血液稀释。患者的平均年龄和体重分别为 48±41（0-306）天和 3.8±0.8（1.3-5.0）kg。CPB 期间的总预充和输血量在 MP 组低于 CP 组（141±24ml 比 292±50ml，P<0.001，82±40ml 比 162±82ml，P<0.001）。在 MP 组中，最小的预充量为 110ml。然而，两组 CPB 期间最低的血细胞比容水平无显著差异（22±3%比 22±3%，P=0.724）。MP 组和 CP 组术后神经系统并发症的发生率无显著差异（1.8%比 2.7%，P=0.509）。在调整先天性心脏手术风险调整类别、体表面积和年龄后，MP 不是术后神经系统并发症或早期死亡率的独立危险因素（P=0.213 和 P=0.467）。MP 方法将预充量减少至约 140ml，而不会增加≤5kg 婴儿的发病率或死亡率的风险。CPB 期间的总输血量减少了 50%，而不会影响血细胞比容水平。我们建议使用小容量预充，这是一种安全有效的减少输血量的方法。
