Benstoem Carina, Bleilevens Christian, Borchard Ralf, Stoppe Christian, Goetzenich Andreas, Autschbach Ruediger, Breuer Thomas
Ann Thorac Cardiovasc Surg. 2018 Oct 19;24(5):230-237. doi: 10.5761/atcs.oa.18-00019. Epub 2018 Jul 11.
Cardiac surgery with the use of extracorporeal circulation is associated with a significant risk for gaseous microemboli (GME) despite excellent surgical techniques and highest operative standards. GME are associated with postoperative neurocognitive dysfunction and negative clinical outcome. This study determines whether oxygenator design has influence on perioperative outcome after cardiac surgery.
Three different oxygenator models with integrated arterial filter (HiliteAF 7000, Fusion Affinity, and Synthesis) were retrospectively evaluated in 55 patients undergoing elective cardiac surgery with the use of extracorporeal circulation. The two-channel ultrasound bubble counter BCC200 was used to detect GME in real time.
All three oxygenators differ in terms of structural specifications and have different rates of number and volume GME reduction. The Fusion Affinity had the lowest arterial GME volume (1.81 µL ± 0.23 µL), which was statistically significant compared to the Synthesis (3.37 µL ± 0.71 µL, p = 0.014). However, the Synthesis had lower absolute numbers at the venous GME count (31771 µL ± 6579 µL) versus the Fusion Affinity (49304 µL ± 8196 µL). However, with regard to clinical outcome after cardiac surgery (duration of invasive and non-invasive mechanical ventilation, incidence of delirium, stroke, acute renal failure, or new myocardial infarction), we found no differences between groups.
Despite significant differences in the design specifications, all oxygenators eliminated relevant GME volumes safely.
尽管手术技术精湛且手术标准极高，但使用体外循环的心脏手术仍存在气态微栓子（GME）的重大风险。GME与术后神经认知功能障碍及不良临床结局相关。本研究旨在确定氧合器设计是否对心脏手术后的围手术期结局有影响。
对55例行择期体外循环心脏手术的患者进行回顾性评估，使用了三种带有集成动脉过滤器的不同氧合器模型（HiliteAF 7000、Fusion Affinity和Synthesis）。使用双通道超声气泡计数器BCC200实时检测GME。
三种氧合器在结构规格方面存在差异，且在减少GME数量和体积的速率上也有所不同。Fusion Affinity的动脉GME体积最低（1.81微升±0.23微升），与Synthesis相比具有统计学意义（3.37微升±0.71微升，p = 0.014）。然而，Synthesis在静脉GME计数方面的绝对数量低于Fusion Affinity（31771微升±6579微升对49304微升±8196微升）。然而，关于心脏手术后的临床结局（有创和无创机械通气时间、谵妄、中风、急性肾衰竭或新发心肌梗死的发生率），我们发现各组之间没有差异。
尽管设计规格存在显著差异，但所有氧合器均能安全地消除相关的GME体积。
