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Beneficial effects of modern perfusion concepts in aortic valve and aortic root surgery

Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany; Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germanykutschka.ingo{at}mh-hannover.de

J Skorpil

Department of Thoracic and Cardiovascular Surgery, Pilsner University Hospital Pilsen, Pilsen, Czech Republic

A El Essawi

Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany

T Hajek

Department of Thoracic and Cardiovascular Surgery, Pilsner University Hospital Pilsen, Pilsen, Czech Republic

W Harringer

Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Germany

Minimized perfusion circuits (MPC) were found to reduce side effects of standard extracorporeal circulation (ECC). We evaluated the safety and efficacy of the ROCsafe^TM MPC for aortic valve and aortic root surgery. One hundred and seventy patients were randomized for surgery using either MPC [n = 85, 30 female/55 male, mean age: 69.8 ± 11.8 years; aortic valve replacement (AVR): n = 40; AVR + coronary artery bypass graft (CABG): n = 31; David operation: n = 3; aortic root replacement (ARR): n = 11] or ECC [n = 85, 29 female/56 male, mean age: 67.7 ± 9.5 years; AVR: n = 39; AVR+CABG: n = 35, David operation: n = 2; ARR: n = 9]. Neurological status, length of ICU stay, C-reactive protein (CRP), blood count, transfusion requirements and bleeding volume were analyzed. The MPC system provided ultrasound-controlled de-airing. A small roller pump and a flexible reservoir were used for left ventricular venting. As a control, we used a standard ECC with cardiotomy suction and hard-shell reservoir. Cross-clamp time (MPC: 76.5 ± 29.5; ECC: 79.0 ± 34.0 min) and bypass time (MPC: 103.0 ± 37.9; ECC: 106.9 ± 44.9 min) were comparable between groups. Transfusion requirements (red blood cells: MPC: 1.5 ± 1.5 vs. ECC: 2.2 ± 2.1 units [p = 0.05], frozen plasma: MPC: 1.2 ± 1.8 vs. ECC: 1.9 ± 2.4 units [p = 0.03]), postoperative bleeding (MPC: 521 ± 283 vs. ECC: 615 ± 326 ml/24 h, p = 0.09) were lower using MPC. ICU stay was shorter with MPC (1.6 ± 1.6 days) compared to ECC (2.4 ± 2.8 days, p = 0.001). One stroke occurred in each group. The ROCsafe^TM MPC provides safe circulatory support for a wide range of aortic valve surgeries. Transfusion requirements, postoperative bleeding and length of ICU stay were markedly reduced compared to standard extracorporeal perfusion.

Key Words: aortic root surgery • aortic valve surgery • inflammation • minimized perfusion • transfusion requirements

Perfusion, Vol. 24, No. 1, 37-44 (2009)
DOI: 10.1177/0267659109106727


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