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Cammertoni F, Bruno P, Pavone N, Farina P, Mazza A, Iafrancesco M, Nesta M, Chiariello GA, Spalletta C, Cavaliere F, Calabrese M, D'Angelo GA, Sanesi V, Conti F, D'Errico D, Massetti M. Influence of cardiopulmonary bypass set-up and management on clinical outcomes after minimally invasive aortic valve surgery. Perfusion 2021; 36:679-687. [PMID: 34080484 DOI: 10.1177/02676591211023301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Federico Cammertoni
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Piero Farina
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Mauro Iafrancesco
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Giovanni A Chiariello
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Claudio Spalletta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Franco Cavaliere
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Maria Calabrese
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | | | | | - Francesco Conti
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Denise D'Errico
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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Djordjević A, Šušak S, Velicki L, Antonič M. ACUTE KIDNEY INJURY AFTER OPEN-HEART SURGERY PROCEDURES. Acta Clin Croat 2021; 60:120-126. [PMID: 34588731 PMCID: PMC8305357 DOI: 10.20471/acc.2021.60.01.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CS-AKI) is a major complication associated with increased morbidity and mortality. There are multiple diagnostic criteria for CS-AKI. Despite many new investigations available for improved AKI diagnostics, creatinine and urea remain the cornerstone of diagnostics in everyday clinical practice. There are three major pathophysiological mechanisms that contribute to kidney injury, i.e. renal hypoperfusion, inflammation with oxidative stress, and use of nephrotoxic agents. Some risk factors have been identified that can be modified during the course of treatment (use of nephrotoxic agents, duration of cardiopulmonary bypass, type of extracorporeal circulation, postoperative low cardiac output or hypotension). The aim of AKI prevention should always be to prevent aggravation of renal failure and, if possible, to avoid progression to renal replacement therapy, which in turn brings worse long-term outcomes.
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Affiliation(s)
| | - Stamenko Šušak
- 1Maribor University Medical Center, Department of Cardiac Surgery, Maribor, Slovenia; 2Institute of Cardiovascular Diseases of Vojvodina, Department of Cardiovascular Surgery, Sremska Kamenica, Serbia; 3University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 4University of Maribor, Faculty of Medicine, Maribor, Slovenia
| | - Lazar Velicki
- 1Maribor University Medical Center, Department of Cardiac Surgery, Maribor, Slovenia; 2Institute of Cardiovascular Diseases of Vojvodina, Department of Cardiovascular Surgery, Sremska Kamenica, Serbia; 3University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 4University of Maribor, Faculty of Medicine, Maribor, Slovenia
| | - Miha Antonič
- 1Maribor University Medical Center, Department of Cardiac Surgery, Maribor, Slovenia; 2Institute of Cardiovascular Diseases of Vojvodina, Department of Cardiovascular Surgery, Sremska Kamenica, Serbia; 3University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; 4University of Maribor, Faculty of Medicine, Maribor, Slovenia
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Missault S, Causenbroeck JV, Vandewiele K, Czapla J, Philipsen T, François K, Bové T. Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery. J Card Surg 2020; 35:3276-3285. [DOI: 10.1111/jocs.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie Missault
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | | | | | - Jens Czapla
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Tine Philipsen
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Katrien François
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
| | - Thierry Bové
- Department of Cardiac Surgery University Hospital of Ghent Ghent Belgium
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