The impact of cardiopulmonary bypass management on outcome: a propensity matched comparison between minimally invasive and conventional valve surgery

Abstract

<jats:title>Abstract</jats:title> <jats:p /> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>Research concerning cardiopulmonary bypass (CPB) management during minimally invasive cardiac surgery (MICS) is scarce. We investigated the effect of CPB parameters such as pump flow, haemoglobin concentration and oxygen delivery on clinical outcome and renal function in a propensity matched comparison between MICS and median sternotomy (MS) for atrioventricular valve surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 356 patients undergoing MICS or MS for atrioventricular valve surgery between 2006 and 2017 were analysed retrospectively. Propensity score analysis matched 90 patients in the MS group with 143 in the MICS group. Logistic regression analysis was performed to investigate independent predictors of cardiac surgery-associated acute kidney injury in patients having MICS.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In MICS, CPB (142.9 ± 39.4 vs 101.0 ± 38.3 min; P &amp;lt; 0.001) and aortic cross-clamp duration (89.9 ± 30.6 vs 63.5 ± 23.0 min; P &amp;lt; 0.001) were significantly prolonged although no differences in clinical outcomes were detected. The pump flow index was lower [2.2 ± 0.2 vs 2.4 ± 0.1 l⋅(min⋅m2)−1; P &amp;lt; 0.001] whereas intraoperative haemoglobin levels were higher (9.25 ± 1.1 vs 8.8 ± 1.2; P = 0.004) and the nadir oxygen delivery was lower [260.8 ± 43.5 vs 273.7 ± 43.7 ml⋅(min⋅m2)−1; P = 0.029] during MICS. Regression analysis revealed that the nadir haemoglobin concentration during CPB was the sole independent predictor of cardiac surgery-associated acute kidney injury (odds ratio 0.67, 95% confidence interval 0.46–0.96; P = 0.029) in MICS but not in MS.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Specific cannulation-related issues lead to CPB management during MICS being confronted with flow restrictions because an average pump flow index ≤2.2 l/min/m2 is achieved in 40% of patients who have MICS compared to those who have a conventional MS. This study showed that increasing the haemoglobin level might be helpful to reduce the incidence of cardiac surgery-associated acute kidney injury after minimally invasive mitral valve surgery.</jats:p> </jats:sec>

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

“…10 In this series, compared to CAVR, CPB and surgery times during MIAVR were prolonged by an average of 12 and 26 minutes, respectively. As already described by other groups, 15,18 these results did not seem to produce worse clinical outcomes. Although it is reasonable to conclude that a longer CPB time may influence outcomes, considering what extent of lengthening would be clinically significant is also always necessary.…”

Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery

“…Using kidney function as the most robust organ function endpoint, our group recently demonstrated that an equivalent organ‐specific, as well as clinical outcome between MIVT and conventional MV surgery, is achievable through targeting a minimal oxygen delivery during the duration of cardiopulmonary bypass. However, to cope with the frequent inferences of intraoperative flow restrictions over a longer procedural time during MIVT, other means need to be applied as the tolerance of lower body temperature, the pursuit of a higher intra‐operative hematocrit level, and the use of blood preserving measures 21 . Moreover, operative times may probably be less decisive for patient outcomes, as long as they are not excessively long.…”

Analysis of clinical outcome and postoperative organ function effects in a propensity-matched comparison between conventional and minimally invasive mitral valve surgery

“…Using kidney function as most robust organ function endpoint, our group recently demonstrated that an equivalent organ-specific as well as clinical outcome between MIVT and conventional MV surgery is achievable through targeting an minimal oxygen delivery during the duration of cardiopulmonary bypass. However, in order to cope with the frequent inferences of intra-operative flow restrictions over a longer procedural time during MIVT, other means need to be applied as the tolerance of lower body temperature, the pursuit of a higher intra-operative hematocrit level and the use of blood preserving measures 21 . Moreover, operative times may probably be less decisive for patient outcomes, as long as they are not excessively long.…”