Aboud Anas, Mederos-Dahms Hendrikje, Liebing Kai, Zittermann Armin, Schubert Harald, Murray Edward, Renner Andre, Gummert Jan, Börgermann Jochen
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
Department of Medical Technology, Friedrich Schiller University, Jena, Germany.
BMC Anesthesiol. 2015 May 29;15:81. doi: 10.1186/s12871-015-0058-0.
Because of its low rate of clinical complications, miniaturized extracorporeal perfusion systems (MEPS) are frequently used in heart centers worldwide. However, many recent studies refer to the higher probability of gaseous microemboli formation by MEPS, caused by subzero pressure values. This is the main reason why various de-airing devices were developed for today's perfusion systems. In the present study, we investigated the potential benefits of a simple one-way-valve connected to a volume replacement reservoir (OVR) for volume and pressure compensation.
In an experimental study on 26 pigs, we compared MEPS (n = 13) with MEPS plus OVR (n = 13). Except OVR, perfusion equipment was identical in both groups. Primary endpoints were pressure values in the venous line and the right atrium as well as the number and volume of air bubbles. Secondary endpoints were biochemical parameters of systemic inflammatory response, ischemia, hemodilution and hemolysis.
One animal was lost in the MEPS + OVR group. In the MEPS + OVR group no pressure values below -150 mmHg in the venous line and no values under -100 mmHg in right atrium were noticed. On the contrary, nearly 20% of venous pressure values in the MEPS group were below -150 and approximately 10% of right atrial pressure values were below -100 mmHg. Compared with the MEPS group, the bubble counter device showed lower numbers of arterial air bubbles in the MEPS + OVR group (mean ± SD: 13444 ± 5709 vs. 1 ± 2, respectively; p < 0.001). In addition, bubble volume was significantly lower in the MEPS + OVR group than in the MEPS group (mean ± SD: 1522 ± 654 μl vs. 4 ± 6 μl, respectively; p < 0.001). The proinflammatory cytokine interleukin-6 and biochemical indices of cardiac ischemia (creatine kinase, and troponin I) were comparable between both groups.
The use of a miniaturized perfusion system with a volume replacement reservoir is able to counteract excessive negative venous line pressures and to reduce the number and volume of arterial air bubbles. This approach may lead to a lower rate of neurological complications.
由于其临床并发症发生率较低，小型体外循环系统（MEPS）在全球心脏中心被广泛使用。然而，最近许多研究指出，MEPS因负压值会导致气体微栓形成的可能性更高。这就是为当今的体外循环系统开发各种排气装置的主要原因。在本研究中，我们调查了连接到容量替代储液器（OVR）的简单单向阀在容量和压力补偿方面的潜在益处。
在一项对26头猪的实验研究中，我们将MEPS组（n = 13）与MEPS加OVR组（n = 13）进行了比较。除了OVR外，两组的灌注设备相同。主要终点是静脉管路和右心房的压力值以及气泡的数量和体积。次要终点是全身炎症反应、缺血、血液稀释和溶血的生化参数。
MEPS + OVR组有1只动物死亡。在MEPS + OVR组中，未发现静脉管路压力值低于-150 mmHg，右心房压力值低于-100 mmHg的情况。相反，MEPS组中近20%的静脉压力值低于-150，约10%的右心房压力值低于-100 mmHg。与MEPS组相比，气泡计数装置显示MEPS + OVR组的动脉气泡数量更少（均值±标准差：分别为13444±5709和1±2；p < 0.001）。此外，MEPS + OVR组的气泡体积明显低于MEPS组（均值±标准差：分别为1522±654 μl和4±6 μl；p < 0.001）。两组之间促炎细胞因子白细胞介素-6以及心脏缺血的生化指标（肌酸激酶和肌钙蛋白I）相当。
使用带有容量替代储液器的小型灌注系统能够抵消静脉管路过度的负压，并减少动脉气泡的数量和体积。这种方法可能会降低神经并发症的发生率。
