Raffaele Silvano, Pietro Giorgio Malvindi, Francesca Mazzocca, Stefania Genova, Emanuele Di Campli, Francesca Paterna, Jacopo M D'Este, Jacopo Alfonsi, Paolo Berretta, Christopher Munch, Marco Di Eusanio
{"title":"Vacuum assisted and gravitational venous drainage in aortic valve surgery: A propensity-match study.","authors":"Raffaele Silvano, Pietro Giorgio Malvindi, Francesca Mazzocca, Stefania Genova, Emanuele Di Campli, Francesca Paterna, Jacopo M D'Este, Jacopo Alfonsi, Paolo Berretta, Christopher Munch, Marco Di Eusanio","doi":"10.1177/02676591241230610","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Vacuum assisted venous drainage (VAVD) is widely adopted in minimally invasive cardiac surgery. VAVD enables the advantage of using smaller cannulae in a reduced surgical field while allowing satisfactory drainage and pump flow. The production of gaseous micro-emboli is a recognized risk associated with VAVD, however no difference in clinical endpoints have been reported between patients operated on with gravity venous drainage (GVD) or with VAVD. Due to the paucity of data on selected surgical populations, we sought to evaluate the early outcomes of patients undergoing isolated aortic valve replacement using VAVD or GVD.</p><p><strong>Methods: </strong>Data on 521 patients between 09/2016 and 09/2022 were retrieved from our internal database. Patients were divided into two groups according to use VAVD or GVD. A propensity match analysis was performed to account for difference between the two groups.</p><p><strong>Results: </strong>The propensity match provided two well balanced cohorts with 129 patients each. A minimally invasive access was used in 97% of the cases in VAVD group vs 98% in GVD group (<i>p</i> = .68). Mean cardiopulmonary by-pass (CPB) time was 71 vs 73 min (<i>p</i> = .74), respectively. There was no difference in lactates peak (<i>p</i> = .19) and urine output during CPB (<i>p</i> = .74). We registered two in-hospital deaths in VAVD cohort (1.6%) vs. no mortality in GVD group (<i>p</i> = .5). Postoperative cerebral stroke occurred in 1 patient in GVD cohort vs. 0 in VAVD (<i>p</i> = 1). Severe postoperative acute kidney injury complicated the course in 16 patients in GVD group and in 5 patients who had VAVD (<i>p</i> = .012). VAVD was associated with a higher number of patients with elevated postoperative AST (<i>p</i> = .07) and Troponin I (<i>p</i> = .01) values.</p><p><strong>Conclusions: </strong>The use of VAVD during isolated aortic valve replacement was not associated with increased risks of postoperative complications and in-hospital mortality with results that were at least similar to those registered in a matched cohort of patients operated on with GVD.</p>","PeriodicalId":49707,"journal":{"name":"Perfusion-Uk","volume":" ","pages":"221-228"},"PeriodicalIF":1.1000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perfusion-Uk","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/02676591241230610","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/25 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Vacuum assisted venous drainage (VAVD) is widely adopted in minimally invasive cardiac surgery. VAVD enables the advantage of using smaller cannulae in a reduced surgical field while allowing satisfactory drainage and pump flow. The production of gaseous micro-emboli is a recognized risk associated with VAVD, however no difference in clinical endpoints have been reported between patients operated on with gravity venous drainage (GVD) or with VAVD. Due to the paucity of data on selected surgical populations, we sought to evaluate the early outcomes of patients undergoing isolated aortic valve replacement using VAVD or GVD.
Methods: Data on 521 patients between 09/2016 and 09/2022 were retrieved from our internal database. Patients were divided into two groups according to use VAVD or GVD. A propensity match analysis was performed to account for difference between the two groups.
Results: The propensity match provided two well balanced cohorts with 129 patients each. A minimally invasive access was used in 97% of the cases in VAVD group vs 98% in GVD group (p = .68). Mean cardiopulmonary by-pass (CPB) time was 71 vs 73 min (p = .74), respectively. There was no difference in lactates peak (p = .19) and urine output during CPB (p = .74). We registered two in-hospital deaths in VAVD cohort (1.6%) vs. no mortality in GVD group (p = .5). Postoperative cerebral stroke occurred in 1 patient in GVD cohort vs. 0 in VAVD (p = 1). Severe postoperative acute kidney injury complicated the course in 16 patients in GVD group and in 5 patients who had VAVD (p = .012). VAVD was associated with a higher number of patients with elevated postoperative AST (p = .07) and Troponin I (p = .01) values.
Conclusions: The use of VAVD during isolated aortic valve replacement was not associated with increased risks of postoperative complications and in-hospital mortality with results that were at least similar to those registered in a matched cohort of patients operated on with GVD.
期刊介绍：
Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
