Centrifugal pump and reduction of neurological risk in adult cardiac surgery.
This study was performed to assess if the kind of pump used for CPB (roller vs. centrifugal) can influence neurological outcomes of adult cardiac surgery patients. Between 1994 and 1998, 3438 patients underwent coronary and/or valve surgery at our hospital; of these, 1805 (52.5%) underwent surgery with the use of a centrifugal pump, and 1633 (47.5%) were operated with a roller pump. The effect of the type of the pump and of common preoperative and intraoperative risk factors for five different neurological outcomes (permanent neurological deficit, coma, delirium, transient neurological deficit, overall neurological complications) were assessed with univariate and multivariate analyses in the whole patients population, in patients > or = 75 years old and in patients with histories of previous neurological events. Centrifugal pump use was the only protective factor for perioperative permanent neurological deficit in multivariable models developed for the whole patient population and for patients > or = 75 years old. In addition, it resulted as the only protective factor for perioperative coma occurrence in multivariable models developed for patients > or = 75 years old, and for patients with histories of previous neurological events. The use of the centrifugal pump provided a risk reduction for the considered events ranging from 23 to 84%. Centrifugal pump use can be helpful in reducing the occurrence of some of the most feared neurological complications of adult cardiac surgery patients.
Alamanni
F
F
Department of Cardiac Surgery, University of Milano, Centro Cardiologico, Fondazione I Monzino IRCCS, Italy.
Parolari
A
A
Zanobini
M
M
Porqueddu
M
M
Dainese
L
L
Bertera
A
A
Costa
C
C
Fusari
M
M
Spirito
R
R
Biglioli
P
P
D000368:Aged; D000704:Analysis of Variance; D001930:Brain Injuries / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation*; D002498:Centrifugation / Q000009:adverse effects / Q000295:instrumentation*; D003128:Coma / Q000209:etiology*; D003693:Delirium / Q000209:etiology*; D005260:Female; D006355:Heart-Lung Machine / Q000009:adverse effects / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*