Centrifugal blood pump use in routine cardiac surgery
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《血管的通路杂志》
St. Elisabeth Department of Heart and Lung Surgery, St. Olavs University Hospital and Faculty of Medicine, Norwegian University of Science and Technology NTNU, Hans Nissens gt. 3, 7018 Trondheim, Norway
Abstract
The literature on the use of centrifugal blood pumps in routine cardiac surgery provides conflicting evidence. Although two large studies revealed a reduction in neurological complications, many smaller studies found no difference in biochemical and clinical parameters. However, there is some evidence that centrifugal pumps perform significantly better in routine surgery compared to roller pumps.
Key Words: Centrifugal pump; Cardiopulmonary bypass; Extracorporeal circulation
The superior blood handling properties of centrifugal blood pumps have led to their universal use in long-term extracorporeal circulation such as ECMO. The scientific evidence for their use in routine cardiac surgery, however, is still debatable. The best evidence paper titled ‘Does the use of a centrifugal pump offer any additional benefit for patients having open heart surgery’ by Asante-Siaw summarizes the literature on this topic [1]. The authors conclude that two large studies demonstrated a reduction of neurological events when a centrifugal pump was used, but that all remaining studies failed to show significant differences.
Unfortunately a number of relevant publications were not included in the best evidence paper. A randomized trial published by our own group from the University of Regensburg was not included in the best evidence paper, although it included more patients than most of the randomized trials referenced [2]. One hundred and twenty patients were randomized to roller pump, centrifugal pump, or roller pump with aprotinin. The aim of the study was to investigate whether centrifugal pumps reduce blood loss during routine surgery to a similar extent as the addition of aprotinin. As shown in the table, we were unable to show such an effect. In addition, analysis of platelet function revealed similar results for all groups (Table 1).
Many of the published studies on centrifugal pumps, including our own, were not powered to show a clinical benefit with respect to mortality, organ failure, stroke, or length of stay in hospital. In addition, most trials included patients undergoing routine coronary surgery with relatively short periods of extracorporeal circulation.
Nevertheless, a reduction in blood trauma when using centrifugal pumps was clearly shown in several in-vitro and in-vivo investigations. A randomized trial published by Jakob and co-workers found an advantage for the centrifugal pump with respect to several laboratory values, such as free hemoglobin, platelet count, and others [3]. Hoerr et al. showed an improved blood handling of centrifugal pumps compared to roller pumps [4].
Combining centrifugal pumps with other modifications of the extracorporeal circuit, aiming at reducing the invasiveness of cardiopulmonary bypass, have been shown to be advantageous, even in routine surgery [5–7].
References
Asante-Siaw J, Tyrell J, Hotchinsky A, Dunning J. Does the use of a centrifugal pump offer any additional benefit for patients having open heart surgery ICVTS doi:10.1510/icvts.2005.126961.
Wahba A, Philipp A, Bauer MF, Kaiser M, Aebert H, Birnbaum DE. The blood saving potential of vortex versus roller pump with and without aprotinin. Perfusion 1995; 10:333–341.
Jakob H, Hafner G, Iversen S, Hake U, Thelemann C, Prellwitz W, Oelert H. Reoperation and the centrifugal pump. Eur J Cardiothorac Surg 1992; 6:S59–S63.
Hoerr HR, Kraemer MF, Williams JL. In vitro comparison of the blood handling by the constrained vortex and twin roller pumps. J Extracorpor Technol 1987; 19:316–321.
Immer FF, Pirovino C, Gygax E, Englberger L, Tevaearai H, Carrel TP. Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg 2005; 28:701–704.
Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Pospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J 2006; 151:198.
Wiesenack C, Liebold A, Philipp A, Ritzka M, Koppenberg J, Birnbaum DE, Keyl C. Four years' experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs 2004; 28:1082–1088.(Alexander Wahba)
Abstract
The literature on the use of centrifugal blood pumps in routine cardiac surgery provides conflicting evidence. Although two large studies revealed a reduction in neurological complications, many smaller studies found no difference in biochemical and clinical parameters. However, there is some evidence that centrifugal pumps perform significantly better in routine surgery compared to roller pumps.
Key Words: Centrifugal pump; Cardiopulmonary bypass; Extracorporeal circulation
The superior blood handling properties of centrifugal blood pumps have led to their universal use in long-term extracorporeal circulation such as ECMO. The scientific evidence for their use in routine cardiac surgery, however, is still debatable. The best evidence paper titled ‘Does the use of a centrifugal pump offer any additional benefit for patients having open heart surgery’ by Asante-Siaw summarizes the literature on this topic [1]. The authors conclude that two large studies demonstrated a reduction of neurological events when a centrifugal pump was used, but that all remaining studies failed to show significant differences.
Unfortunately a number of relevant publications were not included in the best evidence paper. A randomized trial published by our own group from the University of Regensburg was not included in the best evidence paper, although it included more patients than most of the randomized trials referenced [2]. One hundred and twenty patients were randomized to roller pump, centrifugal pump, or roller pump with aprotinin. The aim of the study was to investigate whether centrifugal pumps reduce blood loss during routine surgery to a similar extent as the addition of aprotinin. As shown in the table, we were unable to show such an effect. In addition, analysis of platelet function revealed similar results for all groups (Table 1).
Many of the published studies on centrifugal pumps, including our own, were not powered to show a clinical benefit with respect to mortality, organ failure, stroke, or length of stay in hospital. In addition, most trials included patients undergoing routine coronary surgery with relatively short periods of extracorporeal circulation.
Nevertheless, a reduction in blood trauma when using centrifugal pumps was clearly shown in several in-vitro and in-vivo investigations. A randomized trial published by Jakob and co-workers found an advantage for the centrifugal pump with respect to several laboratory values, such as free hemoglobin, platelet count, and others [3]. Hoerr et al. showed an improved blood handling of centrifugal pumps compared to roller pumps [4].
Combining centrifugal pumps with other modifications of the extracorporeal circuit, aiming at reducing the invasiveness of cardiopulmonary bypass, have been shown to be advantageous, even in routine surgery [5–7].
References
Asante-Siaw J, Tyrell J, Hotchinsky A, Dunning J. Does the use of a centrifugal pump offer any additional benefit for patients having open heart surgery ICVTS doi:10.1510/icvts.2005.126961.
Wahba A, Philipp A, Bauer MF, Kaiser M, Aebert H, Birnbaum DE. The blood saving potential of vortex versus roller pump with and without aprotinin. Perfusion 1995; 10:333–341.
Jakob H, Hafner G, Iversen S, Hake U, Thelemann C, Prellwitz W, Oelert H. Reoperation and the centrifugal pump. Eur J Cardiothorac Surg 1992; 6:S59–S63.
Hoerr HR, Kraemer MF, Williams JL. In vitro comparison of the blood handling by the constrained vortex and twin roller pumps. J Extracorpor Technol 1987; 19:316–321.
Immer FF, Pirovino C, Gygax E, Englberger L, Tevaearai H, Carrel TP. Minimal versus conventional cardiopulmonary bypass: assessment of intraoperative myocardial damage in coronary bypass surgery. Eur J Cardiothorac Surg 2005; 28:701–704.
Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Pospective randomized study comparing coronary artery bypass grafting with the new mini-extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass. Am Heart J 2006; 151:198.
Wiesenack C, Liebold A, Philipp A, Ritzka M, Koppenberg J, Birnbaum DE, Keyl C. Four years' experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs 2004; 28:1082–1088.(Alexander Wahba)