Aortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass

Colli, Andrea; Fernández, C.; Delgado, Luis; Romero, Bernardo Prida; Cámara, María Luisa de la; Ruyra, Xavier

doi:10.1510/icvts.2009.202804

Cited by 15 publications

(17 citation statements)

References 15 publications

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“… 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.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Tsai²,

Chen³

et al. 2016

Medicine

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Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency.From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group.Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P < .001), a greater need for postoperative hemodialysis (14.8% versus 3.1%, P = .009), and prolonged intubation times (>72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05).Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or hemodialysis. Earlier surgical intervention for severe aortic valve disease should be considered in patients who show deteriorating renal function during follow-up.

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Section: Discussionmentioning

confidence: 99%

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

Lin

Tsai²,

Chen³

et al. 2016

Medicine

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Donndorf

Park

Vollmar

et al. 2014

Interact CardioVasc Thorac Surg

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The use of MECC in AVR did not affect procedural safety and, resulted in beneficial preservation of microvascular blood flow velocity and significantly reduced haemodilution during CPB. In contrast to CABG surgery, the use of MECC did not improve FCD during surgical AVR. Clinical advantages possibly resulting from attenuated haemodilution and preservation of microvascular blood flow velocity require further validation in larger patient cohorts.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Sayed¹,

Momen²,

Hassan³

et al. 2014

J Anesth Clin Res

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Background: Cardiopulmonary bypass (CPB) is well known to be associated with a complex physiological response that is clinically manifested as a systemic inflammatory response syndrome. The aim of the study is to compare between the effect of morphine and fentanyl as part of a balanced anesthetic technique on the inflammatory reaction that occurs in cardiac valve replacement surgeries after CPB. Material and methods: Thirty patients undergoing cardiac surgery with cardiopulmonary bypass were randomized to receive either morphine or fentanyl as part of a standardized opioid-isoflurane anesthetic; Group 1 (15 patients received morphine, IV. Group 2 (15 patients received fentanyl. Hemodynamic data were recorded. Serum concentrations of interleukin [(IL)-6 and IL-10] and [(CD 11b, CD 11c, and CD 18] were measured. Results: There was a significant decrease in Heart Rate (HR) and Mean arterial pressure (MAP) in morphine group compared to fentanyl group. However, there were no significant differences between both groups in central venous pressure (CVP) and the incidence of intra operative arrhythmias. Serum levels of IL-6 and IL-8 concentrations increased in all patients after CPB. The increase in serum IL-6 levels was significantly attenuated in the morphine group compared to the fentanyl group at 3 and 24 hrs post CPB (P<0.05). The increase in IL-6 and IL-10 concentrations was significantly attenuated in morphine group compared to the fentanyl group at 4hrs and 24hrs post-CPB (P<0.05). The reduction in adhesion molecules expression (CD 11b, CD 11c and CD 18) were significantly more in the morphine group than in the fentanyl group at 4 hrs and 24 hrs post-CPB (P<0.05). Conclusion: There were perturbations in the release of circulating cytokines, adhesions molecules and postoperative hyperthermia which attenuated by the use of morphine. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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Aortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass

Cited by 15 publications

References 15 publications

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

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

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

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

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