Modified cardiopulmonary bypass with low priming volume for blood conservation in cardiac valve replacement surgery

Journal of Cardiothoracic Surgery

Research

Ruiwu Dai¹  Feng Gao²  Mei Xin²  Xiaohong Wei²  Fan Wu²  Siyi He²  Jinbao Zhang²  Xiaochen Wu²  Ke Yang³  Honghao Huang³ 

[1] College of Medicine, Southwest Jiaotong University, 610036, Chengdu, China;General Surgery Center, General Hospital of Western Theater Command (Chengdu Military General Hospital), 610036, Chengdu, China;Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, 610036, Chengdu, China;Department of Cardiovascular Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), No. 270, Rongdu Rd, Jinniu District, 610036, Chengdu, China;College of Medicine, Southwest Jiaotong University, 610036, Chengdu, China;

关键词: Cardiopulmonary bypass;    Low priming volume;    Blood conservation;    Cardiac surgery;   

DOI  :  10.1186/s13019-023-02175-8

 received in 2022-09-30, accepted in 2023-01-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe adverse effects of cardiopulmonary bypass during open cardiac surgery, including hemodilution, seem to be inevitable, especially for patients who generally have a relatively lower BMI with relatively small blood volumes. This study reports the modification and use of a cardiopulmonary bypass (CPB) system to reduce priming volume and hemodilution.MethodsThis is a retrospective study of 462 adult patients who underwent cardiac valve replacement surgery from January 2019 to September 2021 at the General Hospital of Western Theater Command. The modified group consisted of 212 patients undergoing modified CPB. The control group included 250 patients receiving conventional CPB. Evaluated indices included fluid intake and output volumes during CPB, intraoperative indices related to CPB operation, usage of blood products during the peri-CPB period, and postoperative outcomes.ResultsThe modified group displayed a significant reduction in the crystalloid (200 mL vs. 600 mL, P < 0.05) and colloid priming volumes (450 mL vs. 1100 mL, P < 0.05), and ultrafiltration solution volume (750 mL vs. 1200 mL, P < 0.05). Furthermore, the modified group had a significantly lower rate of defibrillation (30.2% vs. 41.2%, P < 0.05). The intraoperative urine volume (650 mL vs. 500 mL, P < 0.05) and intraoperative hematocrit (Hct) (26% vs. 24%, P < 0.05) of the modified CPB group were also higher than in the control group. The modified group required a lower infusion volume of packed red blood cells (250 mL vs. 400 mL, P < 0.05) and lower infusion rates of packed red blood cells (17.9% vs. 25.2%, P < 0.05) and fresh frozen plasma (1.41% vs. 5.2%, P < 0.05). In addition, the modified group showed significantly improved indices related to postoperative recovery.ConclusionsThe modified CPB system effectively conserves blood and shows noteworthy potential for application in cardiac valve replacement surgery.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

13690_2023_1029_Article_IEq9.gif

Fig. 5

13690_2023_1029_Article_IEq1.gif