Gennari Marco, Rossi Fabiana, Polvani Gianluca, Bertera Antonella, Riva Gianluca, Fave Antonella D, Rassiga Cecilia, Agrifoglio Marco
Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Department of Cardiovascular Sciences and Community Health, University of Milan, Italy.
J Card Surg. 2020 Jan;35(1):158-162. doi: 10.1111/jocs.14347. Epub 2019 Nov 15.
Morbidity associated with coronary artery bypass grafts and embolization during aortic cannulation is strongly related to patient characteristics/comorbidities, arterial cannulation site used and the shape of arterial cannulae tips. The desired features of an arterial cannula should be to mitigate the morbid effects of these cannulas and to focus on achieving higher blood flows with lower cannula pressures (CPs).
To evaluate the in vivo performance of two aortic dispersion flow cannulas: the Optiflow (Sorin Group, Italy) and EZ Glide (Edwards Lifesciences). They were evaluated for CPs, pump-flow rates (FRs), and plasma-free hemoglobin (Hb) over a 12-month period. Data were collected in a prospective, randomized (1:1), nonblinded, monocentric study with a cohort of 30 patients (optiflow group N = 15; EZ Glide group N = 15).
The optiflow cannula was found to have decreasing CPs as the pump FRs were increased (112.3 ± 10.9 vs 131.1 ± 11.4 mm Hg; P < .001). Results indicated no significant differences between groups for increases in plasma free Hb (P = .41) and total microembolic signals counts during the period of cardiac surgery (P = .63).
Both optiflow and EZ Glide dispersion flow arterial cannulas performed well, but the optiflow cannula demonstrated an ability to increase pump FRs with lower arterial line and CPs than the EZ Glide cannula. This implies an ability to improve peripheral perfusion while reducing cannula shear stress and the risk of endothelial damage, thereby having the potential to reduce the risk of atherosclerotic plaque dislodgement.
冠状动脉搭桥术相关的发病率以及主动脉插管期间的栓塞与患者特征/合并症、所使用的动脉插管部位和动脉插管尖端的形状密切相关。动脉插管的理想特性应是减轻这些插管的有害影响,并专注于在较低插管压力(CPs)下实现更高的血流。
为评估两种主动脉分散流插管(Optiflow,意大利索林集团;EZ Glide,爱德华生命科学公司)的体内性能。在12个月的时间里对它们的CPs、泵流速(FRs)和无血浆血红蛋白(Hb)进行了评估。数据收集于一项前瞻性、随机(1:1)、非盲、单中心研究,该研究有30名患者队列(Optiflow组N = 15;EZ Glide组N = 15)。
发现Optiflow插管随着泵FRs的增加CPs降低(112.3±10.9 vs 131.1±11.4 mmHg;P <.001)。结果表明,两组在心脏手术期间血浆游离Hb增加(P = 0.41)和总微栓塞信号计数方面无显著差异(P = 0.63)。
Optiflow和EZ Glide分散流动脉插管均表现良好,但Optiflow插管显示出比EZ Glide插管能够以更低的动脉管路压力和CPs增加泵FRs的能力。这意味着有能力在降低插管剪切应力和内皮损伤风险的同时改善外周灌注,从而有可能降低动脉粥样硬化斑块移位的风险。