Reisinger Maximilian, Kachel Mateusz, Wang Chunhui, Pirelli Luigi, Geirsson Arnar, Argenziano Michael, Kurlansky Paul, Chan Christine, Fung Kenmond, Beck James, George Isaac
Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Clinical Perfusion, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
Perfusion. 2025 Jul 15:2676591251361358. doi: 10.1177/02676591251361358.
IntroductionIncreased time-dose-response (TDR) of suboptimal oxygen delivery (DO) during cardiopulmonary bypass (CPB) has been associated with increased postoperative complications. The impact of surgical approach - minimally invasive vs. median sternotomy - on TDR during mitral valve surgery has not been studied.MethodsAll patients that underwent isolated mitral valve surgery at our institution between 05/2018-06/2024 were included. Perfusion variables were collected continuously (second-to-second) during CPB with a threshold of DO index <300 mL O/min/m (DOi) to quantify depth and duration of insufficient oxygen supply. The primary outcomes used for analysis were maximum and total TDR of DOi. Logistic regression was used to assess the relationship of TDR with surgical outcomes.ResultsA median sternotomy and right minithoracotomy was performed in 377 (84.1%) and 74 (15.9%) patients, respectively. The maximum and total cross-clamp (XC) TDR of DOi (577.7 vs. 91.7 AUC<300 mL O/min/m, <0.0001; 1116.0 vs. 143.1 AUC<300 mL O/min/m, <0.0001) and post-XC TDR of DOi (472.4 vs. 281.0 AUC<300 mL O/min/m, =0.0004; 606.5 vs. 334.4 AUC<300 mL O/min/m, <0.0001) were significantly higher with a right minithoracotomy. Total post-XC TDR of DOi was independently associated with postoperative AKI (OR: 1.271, CI: 1.01-1.6, =0.0413).ConclusionsA right minithoracotomy approach was associated with an increased TDR of DOi. Post-XC TDR of DOi was independently associated with postoperative AKI. These findings highlight the importance of goal-directed-perfusion and the pivotal role of perfusionists in minimally invasive mitral valve surgery.
引言
体外循环（CPB）期间次优氧输送（DO）的时间 - 剂量反应（TDR）增加与术后并发症增加相关。二尖瓣手术中手术方式——微创与正中开胸——对TDR的影响尚未得到研究。
方法
纳入2018年5月至2024年6月在本机构接受单纯二尖瓣手术的所有患者。在CPB期间连续（每秒）收集灌注变量，以DO指数<300 mL O/min/m²（DOi）为阈值，以量化氧气供应不足的深度和持续时间。用于分析的主要结局是DOi的最大和总TDR。采用逻辑回归评估TDR与手术结局的关系。
结果
分别对377例（84.1%）和74例（15.9%）患者进行了正中开胸和右胸小切口手术。右胸小切口手术的DOi的最大和总交叉钳夹（XC）TDR（577.7 vs. 91.7 AUC<300 mL O/min/m²，<0.0001；1116.0 vs. 143.1 AUC<300 mL O/min/m²，<0.0001）以及XC后DOi的TDR（472.4 vs. 281.0 AUC<300 mL O/min/m²，=0.0004；606.5 vs. 334.4 AUC<300 mL O/min/m²，<0.0001）显著更高。DOi的XC后总TDR与术后急性肾损伤独立相关（OR：1.271，CI：1.01 - 1.6，=0.0413）。
结论
右胸小切口手术方式与DOi的TDR增加相关。DOi的XC后TDR与术后急性肾损伤独立相关。这些发现突出了目标导向灌注的重要性以及灌注师在微创二尖瓣手术中的关键作用。
