Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
Artif Organs. 2022 May;46(5):908-921. doi: 10.1111/aor.14145. Epub 2021 Dec 26.
Cardiopulmonary bypass (CPB) during left ventricular assist device (LVAD) implantation provides circulatory support and allows for safe inspection of the left ventricle (LV), whereas circulatory support by veno-arterial extracorporeal life support (va-ECLS) or off-pump implantation may reduce postoperative bleeding and inflammatory response.
Retrospective analysis of 616 consecutive adult patients who received an LVAD via median sternotomy between January 1, 2015 and December 31, 2019. All patients undergoing concomitant intracardiac procedures other than closure of persistent foramen ovale or atrial septal defect and redo surgeries were excluded from the analysis. The remaining patients (n = 222) were divided into two groups and 1:1 propensity score-matched regarding preoperative parameters: patients who underwent LVAD implantation with LV inspection employing CPB (CPB group, n = 62) and without LV inspection on va-ECLS or off-pump (non-CPB group, n = 62).
The groups were well balanced with regard to preoperative baseline characteristics (standard difference <0.1). Patients in the CPB group required more blood transfusions (median 2 vs. 0 units, p = 0.031) during surgery and in the first 24 h afterwards. The median intensive care unit stay was longer in the CPB group (18 vs. 11 days, p = 0.021). The CPB group showed an absence of perioperative stroke and a smaller number of events per patient-year for postoperative ischemic stroke (0.02 vs. 0.12, p = 0.003). 30-day survival (87% vs. 87.1%) and 1-year survival (80.3% vs. 74%) were similar in both groups (p = 0.78).
Visual LV inspection on CPB may reduce the risk of postoperative ischemic stroke. Despite the negative effects of employing CPB in lieu of other intraoperative strategies, survival was similar in both groups.
左心室辅助装置（LVAD）植入过程中的体外循环（CPB）提供循环支持，并允许安全检查左心室（LV），而静脉动脉体外生命支持（va-ECLS）或非体外循环植入的循环支持可能会减少术后出血和炎症反应。
回顾性分析了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间通过正中胸骨切开术接受 LVAD 的 616 例连续成年患者。所有接受除卵圆孔未闭或房间隔缺损闭合和再次手术以外的其他心内手术的患者均被排除在分析之外。其余患者（n=222）分为两组，并根据术前参数进行 1:1 倾向评分匹配：行 CPB 进行 LV 检查的 LVAD 植入术患者（CPB 组，n=62）和不行 LV 检查的 va-ECLS 或非体外循环组（非 CPB 组，n=62）。
两组患者在术前基线特征方面具有良好的均衡性（标准差值<0.1）。CPB 组患者在手术中和术后 24 小时内需要输注更多的血液（中位数 2 比 0 单位，p=0.031）。CPB 组患者的 ICU 住院时间更长（18 比 11 天，p=0.021）。CPB 组无围手术期卒中，且术后缺血性卒中的患者年事件数较少（0.02 比 0.12，p=0.003）。两组 30 天生存率（87%比 87.1%）和 1 年生存率（80.3%比 74%）相似（p=0.78）。
CPB 上的 LV 直观检查可能会降低术后缺血性卒中的风险。尽管 CPB 的使用对其他术中策略有负面影响，但两组的生存率相似。
