Aortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass

Abstract

The purpose of this study was to evaluate the safety and the clinical outcomes of aortic valve replacement (AVR) performed with minimally invasive extracorporeal circulation (miniECC) technique vs. standard cardiopulmonary bypass (CPB). From February 2006 to December 2007 a total of 181 isolated AVR were performed, of these 53 patients were operated using minimal extracorporeal circulation system and 128 patients were operated using the standard CPB. Demographic characteristics and operative data were similar in both groups except for EuroSCORE (P<0.0001). Operative mortality (<30 days) was 3.8% for miniECC group and 4.7% for CPB group (P=ns). Patients in both groups showed similar postoperative chest tube drainage (432+/-325 ml vs. 460+/-331 ml, P=ns). The percentage of transfused patients was similar in both groups (37.7% vs. 43.8%, P=0.45). The number of transfused blood bank products was higher in patients with a body surface area >1.7 m(2) and who underwent traditional CPB in respect to miniECC system. Postoperatively renal injury, atrial fibrillation episodes, neurologic event rate, ICU and hospital stay length were similar in both groups. The miniECC is suitable for AVR providing good clinical results but the present results should not identify the miniECC system to be superior to the conventional CPB.

Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement

“… 22 , 23 Congruent with these suggestions, in the present study, patients with renal insufficiency had significantly longer CPB times (213.9 ± 107.5 minute versus 157 ± 78.6 minute, P = 0.006; Table 1 ) owing to more complex surgical procedures, and the CPB time was prolonged, even after propensity matching; both are much longer than the average CPB duration for isolated AVR cases (59–85 minutes) reported in previous studies. 24 , 25 In addition, Boldt et al reported that patients with a prolonged CPB duration (>90 minutes) had more pronounced kidney damage and reduced postoperative renal function compared with those with shorter CPB durations (<70 min). 26 Furthermore, such dismal effects may be magnified if patients have severe AKI requiring hemodialysis.…”

Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study

“…Facing a continuously ageing patient population and challenged by the rapid development of percutaneous valve procedures in recent years, the need of further reducing CPB-associated morbidity of surgical AVR is obvious. After introduction in coronary artery bypass surgery, MECC systems have also recently been proposed for surgical AVR to reduce adverse effects associated with conventional CPB [10,11]. In coronary artery bypass surgery, several prospective studies were able to show beneficial perioperative effects of the MECC system, i.e.…”

Effect of Morphine and Fentanyl on Inflammatory Biomarkers in Rheumatic Heart Patients Undergoing Valve Replacement Surgery

“…Stoelting and Gibbsb, [12,13] studied the effect of morphine in patients who either had aortic valve or coronary vein graft operations. They agree with our result which found that a dose of 1mg/kg of morphine used alone or with nitrous oxide significantly lowered the arterial pressure.…”