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Published on: September 15, 2023
PERFUSION FOR MYOCARDIAL REVASCULARIZATION WITHOUT AN ARTIFICIAL OXYGENATOR (New Method to Reduce Surgical Morbidity)
Insights
This study introduces a novel heart surgery technique using left ventricle-to-aorta bypass and autogenous oxygenation, eliminating the need for artificial oxygenators. This method appears safer, reducing bleeding and respiratory issues in myocardial revascularization patients.
Area of Science:
- Cardiovascular Surgery
- Medical Technology Innovation
Background:
- Traditional cardiopulmonary bypass relies on artificial oxygenators, which can lead to complications.
- Minimally invasive cardiac procedures aim to reduce patient trauma and recovery time.
Purpose of the Study:
- To evaluate the safety and efficacy of direct myocardial revascularization without an artificial oxygenator.
- To assess the feasibility of using left ventricle-to-aorta bypass with autogenous oxygenation in cardiac surgery.
Main Methods:
- Thirteen patients underwent direct myocardial revascularization using a left ventricle-to-aorta bypass and autogenous oxygenation.
- Procedures involved saphenous vein grafting, often with endarterectomy, under hypothermic cardiac arrest (25-30°C).
- Perfusion flow was maintained at 25-50 ml/kg/min for 45 minutes to 4 hours.
Main Results:
- One hospital death occurred, deemed unrelated to the surgical method.
- No significant bleeding or respiratory dysfunction was observed, with artificial respiration used for only 6-12 hours.
- Patients showed no central nervous system damage post-surgery, and vasopressor use was minimal.
Conclusions:
- Direct myocardial revascularization without artificial oxygenators is feasible and potentially safer.
- This technique may reduce common postoperative complications such as bleeding and respiratory dysfunction.
- Further research with larger patient cohorts is warranted to confirm these preliminary findings.
Abstract:
Thirteen patients were submitted to direct myocardial revascularization (saphenous vein graft) without the use of an artificial oxygenator. The perfusion was done by a left ventricle-to-aorta bypass and autogenous oxygenation. Most patients had three grafts implanted plus endarterectomy of the distal right coronary artery. There was one hospital death that was apparently not related to the method used. Perfusion time ranged from 45 minutes to 4 hours. Body temperature during perfusion was kept between 25 and 30 degrees C. Perfusion flow was maintained between 25 to 50 ml per kg of body weight per minute. Ischemic, hypothermic cardiac arrest was employed. We demonstrated for the first time that perfusion for this kind of heart surgery could be done with no artificial oxygenators and, apparently, is safer for the patients. There were no bleeding problems even in perfusions as long as 4 hours. There was no respiratory dysfunction, and artificial respiration was used for only 6 to 12 hours. The patients awoke at the end of surgery with no signs or symptoms of central nervous system damage, and vasopressor drugs were rarely used after surgery. Although the experience is very small, it suggests that many postoperative problems, especially those related to bleeding and respiratory dysfunction may be reduced or eliminated by this new method.
