title: Comparison of the use of minimized cardiopulmonary bypass with conventional techniques on the incidence of retinal microemboli during aortic valve replacement surgery.
abstract: OBJECTIVE
  Minimized cardiopulmonary bypass (MCPB) circuits have been shown to reduce cerebral and retinal microembolisation during coronary artery bypass graft (CABG) surgery compared to conventional CPB (CCPB) circuits. Our aim was to evaluate whether the reduction of microembolisation is sustained in aortic valve surgery, as well as to evaluate the effects of MCPB on inflammatory, endothelial, and platelet activation markers.
  
  
  METHODS
  Patients were randomized to undergo aortic valve replacement (AVR), with or without CABG, with MPCB (n=20) or CCPB (n=20). After anaesthesia induction and termination of CPB, standardized digital retinal fluorescein angiography images were obtained on both eyes and analyzed in a blinded fashion. Blood samples were collected at eight time points until the third postoperative day.
  
  
  RESULTS
  Fewer patients in the MCPB group showed evidence of microembolic perfusion defects on postperfusion retinal fluorescein angiographs compared to the CCPB group (37% vs. 63%, absolute difference 26%, 95% CI -5% -51%, P = 0.194). Polymorphonuclear leukocyte (PMN) elastase and von Willebrand factor release were statistically significantly reduced in the MCPB group, but there were no significant differences in other markers of inflammation, coagulation or endothelial activation. A significantly higher three-fold increase in the amount of shed blood was collected to the cell saver with a higher rate of intraoperative platelet transfusion in the MCPB group compared to CCPB.
  
  
  CONCLUSIONS
  The use of MCPB was associated statistically insignificantly with less retinal microemboli compared to CCPB. MCPB was complicated by excess bleeding and need for transfusion. The feasibility of MCPB techniques in valve surgery requires further studies.
authors: Department of Anesthesiology and Surgery, Division of Anesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland. riikka.rimpilainen@oulu.fi
authors: R
authors: R
authors: Rimpiläinen
authors: N
authors: N
authors: Hautala
authors: Jk
authors: J
authors: Koskenkari
authors: J
authors: J
authors: Rimpiläinen
authors: Pp
authors: P
authors: Ohtonen
authors: P
authors: P
authors: Mustonen
authors: H-M
authors: HM
authors: Surcel
authors: E-R
authors: ER
authors: Savolainen
authors: M
authors: M
authors: Mosorin
authors: Ti
authors: T
authors: Ala-Kokko
authors: T
authors: T
authors: Juvonen
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation*; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000276:immunology; D055806:Microvessels / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012160:Retina / Q000000981:diagnostic imaging / Q000473:pathology*