Magunia Harry, Nester Jana, Sandoval Boburg Rodrigo, Schlensak Christian, Rosenberger Peter, Hofbeck Michael, Keller Marius, Neunhoeffer Felix
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
J Cardiovasc Dev Dis. 2022 Dec 5;9(12):436. doi: 10.3390/jcdd9120436.
Background: Lower body perfusion (LBP) may be a strategy for maintaining organ perfusion during congenital heart disease surgery. It is hypothesized that renal and lower limb oxygen supply during LBP is superior to off-pump surgery and comparable to that of a standard cardiopulmonary bypass (CPB). Methods: in this prospective single-center study, patients aged <1 year were recruited if they were scheduled for a correction of aortic arch anomalies using antegrade cerebral perfusion and LBP (group 1), a repair of coarctation during aortic cross-clamping (group 2), or surgery under whole-body CPB (group 3). Renal (prefix “r”) and peripheral (prefix “p”) oxygen saturation (SO2), hemoglobin amount (Hb), blood velocity (Velo), and blood flow (Flow) were measured noninvasively. Results: A total of 23 patients were included (group 1, n = 9; group 2, n = 5; group 3, n = 9). Compared to the baseline values, rSO2 and pSO2 decreased significantly in group 2 compared to groups 1 and 3. Conversely, rHB significantly increased in group 2 compared to groups 1 and 3, reflecting abdominal venous stasis. Compared to group 3, group 1 showed a significantly lower pFlow during CPB; however, rFlow, pFlow, and pVelo did not differ. Conclusion: according to these observations, LBP results in an improved renal oxygen supply compared to off-pump surgery and may prove to be a promising alternative to conventional CPB.
下身灌注（LBP）可能是先天性心脏病手术期间维持器官灌注的一种策略。据推测，LBP期间肾脏和下肢的氧气供应优于非体外循环手术，且与标准体外循环（CPB）相当。方法：在这项前瞻性单中心研究中，招募年龄小于1岁、计划采用顺行性脑灌注和LBP矫正主动脉弓畸形的患者（1组）、在主动脉交叉钳夹期间修复缩窄的患者（2组）或在全身CPB下进行手术的患者（3组）。无创测量肾脏（前缀“r”）和外周（前缀“p”）血氧饱和度（SO2）、血红蛋白量（Hb）、血流速度（Velo）和血流量（Flow）。结果：共纳入23例患者（1组，n = 9；2组，n = 5；3组，n = 9）。与基线值相比，2组的rSO2和pSO2较1组和3组显著降低。相反，与1组和3组相比，2组的rHB显著升高，反映出腹部静脉淤血。与3组相比，1组在CPB期间的pFlow显著较低；然而，rFlow、pFlow和pVelo无差异。结论：根据这些观察结果，与非体外循环手术相比，LBP可改善肾脏氧气供应，可能是传统CPB的一种有前景的替代方法。
