Centrifugal Pump and Roller Pump in Adult Cardiac Surgery: A Meta‐Analysis of Randomized Controlled Trials

Abstract

Centrifugal pump (CP) and roller pump (RP) designs are the dominant main arterial pumps used in cardiopulmonary bypass (CPB). Trials reporting clinical outcome measures comparing CP and RP are controversial. Therefore, a meta‐analysis was undertaken to evaluate clinical variables from randomized controlled trials (RCTs). Keyword searches were performed on Medline (1966–2011), EmBase (1980–2011), and CINAHL (1981–2011) for studies comparing RP and CP as the main arterial pump in adult CPB. Pooled fixed‐effects estimates for dichotomous and continuous data were calculated as an odds ratio and weighted‐mean difference, respectively. The P value was utilized to assess statistical significance (P < 0.05) between CP and RP groups. Eighteen RCTs met inclusion criteria, which represented 1868 patients (CP = 961, RP = 907). The prevailing operation was isolated coronary artery bypass graft surgery (CP = 88%, RP = 87%). Fixed‐effects pooled estimates were performed for end‐of‐CPB (ECP) and postoperative day one (PDO) for platelet count (ECP: P = 0.51, PDO: P = 0.16), plasma free hemoglobin (ECP: P = 0.36, PDO: P = 0.24), white blood cell count (ECP: P = 0.21, PDO: P = 0.66), and hematocrit (ECP: P = 0.06, PDO: P = 0.51). No difference was demonstrated for postoperative blood loss (P = 0.65) or red blood cell transfusion (P = 0.71). Intensive care unit length of stay (P = 0.30), hospital length of stay (P = 0.33), and mortality (P = 0.91) were similar between the CP and RP groups. Neurologic outcomes were not amenable to pooled analysis; nevertheless, the results were inconclusive. There was no reported pump‐related malfunction or mishap. The meta‐analysis of RCTs comparing CP and RP in adult cardiac surgery suggests no significant difference for hematological variables, postoperative blood loss, transfusions, neurological outcomes, or mortality.

Platelet Microvesicles (Microparticles) in Cardiac Surgery

“…54,55 There is no evidence favoring either type of pump in terms of hematologic or coagulation parameters, postoperative blood loss, blood transfusion, neurologic outcome, or mortality, 41,[56][57][58] since the effects of antifibrinolytic drugs and mild hypothermia probably overshadow any small differences between pump types. 41 However, damage to platelets and red cells, and the inflammatory response, may be worse with prolonged CPB using roller pumps.…”

Platelet Function During Cardiopulmonary Bypass Using Multiple Electrode Aggregometry: Comparison of Centrifugal and Roller Pumps

“…Heparin coating may have a greater influence on platelet activation than pump type (7), and shorter pump runs may overshadow the effect of pump head design on hemostasis (9). We therefore utilized non-heparin-coated circuits and ran CPB for as long as 3 h. The lack of clear clinical benefits has reduced the use of the more expensive CPs; in Europe, for example, only 10% of CPBs are performed using CPs (33), which is a trend supported by our results.…”

Impact of Vacuum-Assisted Venous Drainage on Forward Flow in Simulated Pediatric Cardiopulmonary Bypass Circuits Utilizing a Centrifugal Arterial Pump Head

“…Until now, to the best of our knowledge, there is no evidence-based difference in hematologic parameters and clinical outcomes with the use of a CP or RP as the main arterial pump in adult cardiac surgery [8] . Despite no superior advantage of CPs over RPs, CPs are used in 51% of CPB cases in Brazil, in both pediatric and adult patients [9] .…”