Influence of cardiopulmonary bypass set-up and management on clinical outcomes after minimally invasive aortic valve surgery

Abstract

Introduction: Minimally invasive aortic valve replacement (MIAVR) requires changes in cannulation strategy and cardiopulmonary bypass (CPB) management when compared to the conventional approach (CAVR). We aimed at evaluating if these differences could influence perfusion-related quality parameters and impair postoperative outcomes. Methods: Overall, 339 consecutive patients underwent MIAVR or CAVR between 2014 and 2020 and were analyzed retrospectively. To account for baseline differences, a propensity-matching analysis was performed, obtaining two groups of 97 patients each. Results: MIAVR group had longer CPB time [107 (95–120) vs 95 (86–105) min, p = .003] than CAVR group. Of note, average pump flow rate index [2.4 (2.2–2.5) vs 2.7 (2.4–2.8) l/min/m2, p = .004] was lower in the MIAVR group. Mean arterial pressure was 73 = 9 mmHg vs 62 = 11 mmHg for the MIAVR and CAVR group, respectively (p < .001). Cell-salvaged blood was most commonly used in the MIAVR group (25.8% vs 11.3%, p = .02). Finally, CPB temperature was 32.8°C (32.1–34.8) for MIAVR group vs 34.9°C (33.2–36.1) for the CAVR group (p = .02). Postoperative complications were similar between groups. Conclusions: In conclusion, despite differences in CPB parameters in patients undergoing CAVR and MIAVR, the incidences of adverse outcomes were similar. However, compared to CAVR, MIAVR was associated with shorter durations of mechanical ventilation and hospital stay as well as less transfusion of blood products.

Outcomes of Minimally Invasive Aortic Valve Replacement in Obese Patients: A Propensity-Matched Study

“…More details on surgical technique, extracorporeal circulation setup, and anaesthesia management have been previously described [ 13 , 14 ] .…”

Effect of aortic cannulation depth on air emboli transport during cardiopulmonary bypass: A computational study

“…A potential pump flow range could occur between normothermic (2.4 L/min/m 2 ) and hypothermic (1.2 L/min/m 2 ) temperatures as a function of the patient's physiology, surgical goal and metabolic targets. 1,30 In contrast, current numerical CFD cannula studies use a constant pump flow rate in the range of 4-5 L/min. 29,[31][32][33] Therefore, to determine the interaction of pump flow, two extreme differential non-pulsatile flows of 2 L/min and 5 L/min were arbitrarily chosen.…”

“…The aetiology of arterial microemboli during cardiopulmonary bypass (CPB) has been well studied, yet the potential for cerebral embolism remains. 1,2 Research has focused on mitigating gaseous and particulate microemboli with techniques ranging from blood and gas management, temperature control, patient reorientation (Trendelenburg), deairing procedures and improving surgical equipment. 3 A specific area that has been a constant focus of microembolic research is the area of aortic cannulation, particularly the arterial cannula, where its type and implementation are associated with microemboli observed during cardiac surgery.…”

Papaverine Infusion Through Aortic Root before Cardiac Self-recovery in Heart Valve Replacement with TiO2 Nanocrystalline Film Material

“…With the continuous improvement of cardiac surgery and CPB application technology, the effectiveness and safety of open-heart surgery in the treatment of heart valve disease have been guaranteed. However, postoperative myocardial injury is still a risk factor for complications after CPB open heart surgery, and excellent myocardial protection directly affects the success or failure of cardiac surgery and patient prognosis (18)(19)(20). In this work, papaverine was used to improve the rate of cardiac self-recovery.…”