Carrel Thierry
Departement of Cardiac Surgery, University of Zürich, CH-8006 Zürich, Switzerland.
Department of Cardiac Surgery, University Hospital Basel, CH-4052 Basel, Switzerland.
J Cardiovasc Dev Dis. 2023 Jul 7;10(7):290. doi: 10.3390/jcdd10070290.
The aim of cardiopulmonary bypass is the maintenance of a sufficient whole body perfusion and gas exchange during open or closed heart surgery procedure (coronary artery bypass grafting, valve repair and replacement, surgical intervention on the ascending aorta and/or aortic arch, repair of congenital malformations, and finally implantation of ventricular assist devices or cardiac transplantation). The main components of cardiopulmonary bypass are the pump that supplies the circulation and the oxygenator that regulates gas exchange. However, even though this technology has been extensively developed and improved over the last decades, one of the major drawbacks-which is the fact that blood has to flow through tubing systems with foreign surfaces-persists so far. Nevertheless, interesting innovations have been made more recently in order to better control the side-effects that culminate into a major activation of the coagulation and inflammatory systems: among them, miniaturization of the circuits, together with reduction of the priming volume and a simplified cardioplegia concept. All of these lead to a significant decrease of hemodilution and thereby a significant reduction of volume overload during surgery. In this brief review we will present some of these most interesting topics around minimized circuits and the simplified low-volume cardioplegia and discuss their potential benefits on the clinical outcome.
体外循环的目的是在心脏直视手术或非心脏直视手术过程中（冠状动脉搭桥术、瓣膜修复与置换术、升主动脉和/或主动脉弓手术干预、先天性畸形修复，以及最后植入心室辅助装置或心脏移植）维持充足的全身灌注和气体交换。体外循环的主要组成部分是提供循环的泵和调节气体交换的氧合器。然而，尽管这项技术在过去几十年中得到了广泛发展和改进，但一个主要缺点——血液必须流经带有异物表面的管道系统——至今仍然存在。尽管如此，最近还是有一些有趣的创新，以便更好地控制最终导致凝血和炎症系统大量激活的副作用：其中包括回路的小型化，以及减少预充量和简化心脏停搏液概念。所有这些都导致血液稀释显著减少，从而在手术期间显著降低容量超负荷。在这篇简短的综述中，我们将介绍一些围绕最小化回路和简化的低容量心脏停搏液的最有趣的话题，并讨论它们对临床结果的潜在益处。
