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首页> 外文期刊>Artificial Organs >Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial
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Cerebral Microembolization During Aortic Valve Replacement Using Minimally Invasive or Conventional Extracorporeal Circulation: A Randomized Trial

机译：使用微创或常规体外循环在主动脉瓣置换过程中进行脑微栓塞：一项随机试验

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摘要

To compare intraoperative cerebral microembolic load between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) during isolated surgical aortic valve replacement (SAVR), we conducted a randomized trial in patients undergoing primary elective SAVR at a tertiary referral hospital. The primary outcome was the procedural phase-related rate of high-intensity transient signals (HITS) on transcranial Doppler ultrasound. HITS rate was used as a surrogate of cerebral microembolism in pre-defined procedural phases in SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with integrated arterial filter. Forty-eight patients were randomized in a 1: 1 ratio to MiECC or CECC. Due to intraprocedural Doppler signal loss (n=3), 45 patients were included in final analysis. MiECC perfusion regimen showed a significantly increased HITS rate compared to CECC (by a factor of 1.75; 95% confidence interval, 1.19-2.56). This was due to different HITS rates in procedural phases from aortic cross-clamping until declamping [phase 4] (P=0.01), and from aortic declamping until stop of extracorporeal perfusion [phase 5] (P=0.05). Post hoc analysis revealed that MiECC-F generated a higher HITS rate than CECC+F (P=0.005), CECC-F (P=0.05) in phase 4, and CECC-F (P=0.03) in phase 5, respectively. In open-heart surgery, MiECC is not superior to CECC with regard to gaseous cerebral microembolism. When using MiECC for SAVR, the use of oxygenators with integrated arterial line filter appears highly advisable. Only with this precaution, MiECC confers a cerebral microembolic load comparable to CECC during this type of open heart surgery.
机译：为了比较隔离主动脉瓣膜置换术（SAVR）期间微创体外循环（MiECC）和常规体外循环（CECC）的术中脑微栓塞负荷，我们在一家三级转诊医院接受初选SAVR的患者中进行了一项随机试验。主要结果是经颅多普勒超声检查与程序阶段相关的高强度瞬时信号（HITS）的发生率。使用MiECC或CECC（带（+ F）或不带（-F）带有内置动脉过滤器的充氧器），在SAVR的预定义程序阶段中，将HITS率用作脑微栓塞的替代指标。 48位患者按照与MiECC或CECC的1：1比例随机分配。由于术中多普勒信号丢失（n = 3），最终分析中包括了45例患者。与CECC相比，MiECC灌注方案显示出HITS率显着提高（系数为1.75; 95％置信区间为1.19-2.56）。这是由于在从主动脉交叉钳夹直至钳夹[阶段4]（P = 0.01）和从主动脉钳夹直至体外灌注停止[阶段5]（P = 0.05）的程序阶段，HITS率不同。事后分析显示，MiECC-F产生的HITS率分别高于第4阶段的CECC + F（P = 0.005），CECC-F（P = 0.05）和第5阶段的CECC-F（P = 0.03）。在心脏直视手术中，就气态脑微栓塞而言，MiECC并不优于CECC。将MiECC用于SAVR时，强烈建议使用带有集成式动脉管路过滤器的充氧器。只有采取这种预防措施，MiECC才能在这种类型的心脏直视手术中赋予与CECC相当的脑微栓塞负荷。

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