Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study
OBJECTIVES Closed minimal extracorporeal circulation (MECC) systems currently do not represent the standard of surgical care for open-heart surgery. Yet, considering the beneficial results reported for coronary artery bypass graft (CABG) surgery, we used an MECC system in aortic valve replacement (A...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2014-08, Vol.19 (2), p.211-217 |
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| creator | Donndorf, Peter Park, Hannah Vollmar, Brigitte Alms, Angela Gierer, Philipp Steinhoff, Gustav Kaminski, Alexander |
| description | OBJECTIVES
Closed minimal extracorporeal circulation (MECC) systems currently do not represent the standard of surgical care for open-heart surgery. Yet, considering the beneficial results reported for coronary artery bypass graft (CABG) surgery, we used an MECC system in aortic valve replacement (AVR) and analysed the effects on intraoperative microvascular perfusion in comparison with conventional open extracorporeal circulation (CECC).
METHODS
In the current study, we analysed alterations in microvascular perfusion at 4 predefined time points (T1–T4) during surgical AVR utilizing orthogonal polarization spectral (OPS) imaging. Twenty patients were randomized for being operated on utilizing either MECC or CECC. Changes in functional capillary density (FCD, cm/cm2), mircovascular blood flow velocity (mm/s) and vessel diameter (μm) were analysed by a blinded investigator.
RESULTS
After the start of extracorporeal circulation and aortic cross-clamping (T2), both groups showed a significant drop in FCD, but with a significantly higher FCD in the MECC group (153.1 ± 15.0 cm/cm² in the CECC group vs 160.8 ± 12.2 cm/cm² in the MECC group, P = 0.034). During the late phase of the cardiopulmonary bypass (CPB) (T3), the FCD was still significantly depressed in both treatment groups (153.5 ± 14.6 cm/cm² in the CECC group, P |
| doi_str_mv | 10.1093/icvts/ivu131 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_TOX</sourceid><recordid>TN_cdi_proquest_miscellaneous_1546215887</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/icvts/ivu131</oup_id><sourcerecordid>1546215887</sourcerecordid><originalsourceid>FETCH-LOGICAL-c361t-1d711bbac14c5117c9ed0d609000020a285b319b2a924e05959f51daae0bc1f93</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi0EoqVw44x8gwNLPXGSXXOrKj4qVeIC52gynqyMkjj4I6L8Ln4gDlt6xLLksfW8M-N5hXgJ6h0ooy8drSleujWDhkfiHJrW7Ex1aB4_xEafiWcxflcKjNLqqTir6r1pta7Pxe-baUFK0g-SRh_ZysnNbsJR8s8UkHxYfOByJRcoj5icn2XZk6PgV4zbW5DJxZhZLhyGHDfC5uDmo4w5HB0VNfqQHMkVx5Vl4GVE4onn9F66uZRZXSpQKXvcVG6WKJfg48KU3CbA2frJ_SrdxZTt3XPxZMAx8ov780J8-_jh6_Xn3e2XTzfXV7c70i2kHdg9QN8jQU0NwJ4MW2VbZVRZlcIypF6D6Ss0Vc2qMY0ZGrCIrHqCwegL8eaUtzTzI3NM3eQi8TjizD7HDpq6raA5HPYFfXtCy1hiDDx0Syj_CXcdqG7zqfvrU3fyqeCv7jPnfmL7AP8zpgCvT4DPy_9T_QG2PaQA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1546215887</pqid></control><display><type>article</type><title>Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study</title><source>Oxford Journals Open Access Collection</source><creator>Donndorf, Peter ; Park, Hannah ; Vollmar, Brigitte ; Alms, Angela ; Gierer, Philipp ; Steinhoff, Gustav ; Kaminski, Alexander</creator><creatorcontrib>Donndorf, Peter ; Park, Hannah ; Vollmar, Brigitte ; Alms, Angela ; Gierer, Philipp ; Steinhoff, Gustav ; Kaminski, Alexander</creatorcontrib><description>OBJECTIVES
Closed minimal extracorporeal circulation (MECC) systems currently do not represent the standard of surgical care for open-heart surgery. Yet, considering the beneficial results reported for coronary artery bypass graft (CABG) surgery, we used an MECC system in aortic valve replacement (AVR) and analysed the effects on intraoperative microvascular perfusion in comparison with conventional open extracorporeal circulation (CECC).
METHODS
In the current study, we analysed alterations in microvascular perfusion at 4 predefined time points (T1–T4) during surgical AVR utilizing orthogonal polarization spectral (OPS) imaging. Twenty patients were randomized for being operated on utilizing either MECC or CECC. Changes in functional capillary density (FCD, cm/cm2), mircovascular blood flow velocity (mm/s) and vessel diameter (μm) were analysed by a blinded investigator.
RESULTS
After the start of extracorporeal circulation and aortic cross-clamping (T2), both groups showed a significant drop in FCD, but with a significantly higher FCD in the MECC group (153.1 ± 15.0 cm/cm² in the CECC group vs 160.8 ± 12.2 cm/cm² in the MECC group, P = 0.034). During the late phase of the cardiopulmonary bypass (CPB) (T3), the FCD was still significantly depressed in both treatment groups (153.5 ± 14.6 cm/cm² in the CECC group, P <0.05 vs ‘T1’; 159.5 ± 12.4 cm/cm² in the MECC group, P <0.05 versus ‘T1’). After termination of CPB (T4), the FCD recovered in both groups to baseline values. Microvascular blood flow velocity tended to remain at a higher level in the MECC group, whereas haemodilution during CPB was significantly reduced in the MECC group.
CONCLUSIONS
The use of MECC in AVR did not affect procedural safety and, resulted in beneficial preservation of microvascular blood flow velocity and significantly reduced haemodilution during CPB. In contrast to CABG surgery, the use of MECC did not improve FCD during surgical AVR. Clinical advantages possibly resulting from attenuated haemodilution and preservation of microvascular blood flow velocity require further validation in larger patient cohorts.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivu131</identifier><identifier>PMID: 24796334</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnosis ; Aortic Valve Insufficiency - physiopathology ; Aortic Valve Insufficiency - surgery ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Blood Flow Velocity ; Cardiopulmonary Bypass ; Extracorporeal Membrane Oxygenation - adverse effects ; Female ; Germany ; Heart Valve Prosthesis Implantation - adverse effects ; Hemodilution ; Humans ; Male ; Microcirculation ; Microscopy, Polarization ; Microscopy, Video ; Middle Aged ; Monitoring, Intraoperative ; Mouth Mucosa - blood supply ; Predictive Value of Tests ; Prospective Studies ; Regional Blood Flow ; Time Factors ; Treatment Outcome</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2014-08, Vol.19 (2), p.211-217</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-1d711bbac14c5117c9ed0d609000020a285b319b2a924e05959f51daae0bc1f93</citedby><cites>FETCH-LOGICAL-c361t-1d711bbac14c5117c9ed0d609000020a285b319b2a924e05959f51daae0bc1f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1604,27924,27925</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/icvts/ivu131$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24796334$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Donndorf, Peter</creatorcontrib><creatorcontrib>Park, Hannah</creatorcontrib><creatorcontrib>Vollmar, Brigitte</creatorcontrib><creatorcontrib>Alms, Angela</creatorcontrib><creatorcontrib>Gierer, Philipp</creatorcontrib><creatorcontrib>Steinhoff, Gustav</creatorcontrib><creatorcontrib>Kaminski, Alexander</creatorcontrib><title>Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>OBJECTIVES
Closed minimal extracorporeal circulation (MECC) systems currently do not represent the standard of surgical care for open-heart surgery. Yet, considering the beneficial results reported for coronary artery bypass graft (CABG) surgery, we used an MECC system in aortic valve replacement (AVR) and analysed the effects on intraoperative microvascular perfusion in comparison with conventional open extracorporeal circulation (CECC).
METHODS
In the current study, we analysed alterations in microvascular perfusion at 4 predefined time points (T1–T4) during surgical AVR utilizing orthogonal polarization spectral (OPS) imaging. Twenty patients were randomized for being operated on utilizing either MECC or CECC. Changes in functional capillary density (FCD, cm/cm2), mircovascular blood flow velocity (mm/s) and vessel diameter (μm) were analysed by a blinded investigator.
RESULTS
After the start of extracorporeal circulation and aortic cross-clamping (T2), both groups showed a significant drop in FCD, but with a significantly higher FCD in the MECC group (153.1 ± 15.0 cm/cm² in the CECC group vs 160.8 ± 12.2 cm/cm² in the MECC group, P = 0.034). During the late phase of the cardiopulmonary bypass (CPB) (T3), the FCD was still significantly depressed in both treatment groups (153.5 ± 14.6 cm/cm² in the CECC group, P <0.05 vs ‘T1’; 159.5 ± 12.4 cm/cm² in the MECC group, P <0.05 versus ‘T1’). After termination of CPB (T4), the FCD recovered in both groups to baseline values. Microvascular blood flow velocity tended to remain at a higher level in the MECC group, whereas haemodilution during CPB was significantly reduced in the MECC group.
CONCLUSIONS
The use of MECC in AVR did not affect procedural safety and, resulted in beneficial preservation of microvascular blood flow velocity and significantly reduced haemodilution during CPB. In contrast to CABG surgery, the use of MECC did not improve FCD during surgical AVR. Clinical advantages possibly resulting from attenuated haemodilution and preservation of microvascular blood flow velocity require further validation in larger patient cohorts.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Insufficiency - diagnosis</subject><subject>Aortic Valve Insufficiency - physiopathology</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Blood Flow Velocity</subject><subject>Cardiopulmonary Bypass</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Female</subject><subject>Germany</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Hemodilution</subject><subject>Humans</subject><subject>Male</subject><subject>Microcirculation</subject><subject>Microscopy, Polarization</subject><subject>Microscopy, Video</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative</subject><subject>Mouth Mucosa - blood supply</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Regional Blood Flow</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EoqVw44x8gwNLPXGSXXOrKj4qVeIC52gynqyMkjj4I6L8Ln4gDlt6xLLksfW8M-N5hXgJ6h0ooy8drSleujWDhkfiHJrW7Ex1aB4_xEafiWcxflcKjNLqqTir6r1pta7Pxe-baUFK0g-SRh_ZysnNbsJR8s8UkHxYfOByJRcoj5icn2XZk6PgV4zbW5DJxZhZLhyGHDfC5uDmo4w5HB0VNfqQHMkVx5Vl4GVE4onn9F66uZRZXSpQKXvcVG6WKJfg48KU3CbA2frJ_SrdxZTt3XPxZMAx8ov780J8-_jh6_Xn3e2XTzfXV7c70i2kHdg9QN8jQU0NwJ4MW2VbZVRZlcIypF6D6Ss0Vc2qMY0ZGrCIrHqCwegL8eaUtzTzI3NM3eQi8TjizD7HDpq6raA5HPYFfXtCy1hiDDx0Syj_CXcdqG7zqfvrU3fyqeCv7jPnfmL7AP8zpgCvT4DPy_9T_QG2PaQA</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Donndorf, Peter</creator><creator>Park, Hannah</creator><creator>Vollmar, Brigitte</creator><creator>Alms, Angela</creator><creator>Gierer, Philipp</creator><creator>Steinhoff, Gustav</creator><creator>Kaminski, Alexander</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study</title><author>Donndorf, Peter ; Park, Hannah ; Vollmar, Brigitte ; Alms, Angela ; Gierer, Philipp ; Steinhoff, Gustav ; Kaminski, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-1d711bbac14c5117c9ed0d609000020a285b319b2a924e05959f51daae0bc1f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Insufficiency - diagnosis</topic><topic>Aortic Valve Insufficiency - physiopathology</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Blood Flow Velocity</topic><topic>Cardiopulmonary Bypass</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Female</topic><topic>Germany</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Hemodilution</topic><topic>Humans</topic><topic>Male</topic><topic>Microcirculation</topic><topic>Microscopy, Polarization</topic><topic>Microscopy, Video</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative</topic><topic>Mouth Mucosa - blood supply</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Regional Blood Flow</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Donndorf, Peter</creatorcontrib><creatorcontrib>Park, Hannah</creatorcontrib><creatorcontrib>Vollmar, Brigitte</creatorcontrib><creatorcontrib>Alms, Angela</creatorcontrib><creatorcontrib>Gierer, Philipp</creatorcontrib><creatorcontrib>Steinhoff, Gustav</creatorcontrib><creatorcontrib>Kaminski, Alexander</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Donndorf, Peter</au><au>Park, Hannah</au><au>Vollmar, Brigitte</au><au>Alms, Angela</au><au>Gierer, Philipp</au><au>Steinhoff, Gustav</au><au>Kaminski, Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>19</volume><issue>2</issue><spage>211</spage><epage>217</epage><pages>211-217</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>OBJECTIVES
Closed minimal extracorporeal circulation (MECC) systems currently do not represent the standard of surgical care for open-heart surgery. Yet, considering the beneficial results reported for coronary artery bypass graft (CABG) surgery, we used an MECC system in aortic valve replacement (AVR) and analysed the effects on intraoperative microvascular perfusion in comparison with conventional open extracorporeal circulation (CECC).
METHODS
In the current study, we analysed alterations in microvascular perfusion at 4 predefined time points (T1–T4) during surgical AVR utilizing orthogonal polarization spectral (OPS) imaging. Twenty patients were randomized for being operated on utilizing either MECC or CECC. Changes in functional capillary density (FCD, cm/cm2), mircovascular blood flow velocity (mm/s) and vessel diameter (μm) were analysed by a blinded investigator.
RESULTS
After the start of extracorporeal circulation and aortic cross-clamping (T2), both groups showed a significant drop in FCD, but with a significantly higher FCD in the MECC group (153.1 ± 15.0 cm/cm² in the CECC group vs 160.8 ± 12.2 cm/cm² in the MECC group, P = 0.034). During the late phase of the cardiopulmonary bypass (CPB) (T3), the FCD was still significantly depressed in both treatment groups (153.5 ± 14.6 cm/cm² in the CECC group, P <0.05 vs ‘T1’; 159.5 ± 12.4 cm/cm² in the MECC group, P <0.05 versus ‘T1’). After termination of CPB (T4), the FCD recovered in both groups to baseline values. Microvascular blood flow velocity tended to remain at a higher level in the MECC group, whereas haemodilution during CPB was significantly reduced in the MECC group.
CONCLUSIONS
The use of MECC in AVR did not affect procedural safety and, resulted in beneficial preservation of microvascular blood flow velocity and significantly reduced haemodilution during CPB. In contrast to CABG surgery, the use of MECC did not improve FCD during surgical AVR. Clinical advantages possibly resulting from attenuated haemodilution and preservation of microvascular blood flow velocity require further validation in larger patient cohorts.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>24796334</pmid><doi>10.1093/icvts/ivu131</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Insufficiency - diagnosis Aortic Valve Insufficiency - physiopathology Aortic Valve Insufficiency - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Blood Flow Velocity Cardiopulmonary Bypass Extracorporeal Membrane Oxygenation - adverse effects Female Germany Heart Valve Prosthesis Implantation - adverse effects Hemodilution Humans Male Microcirculation Microscopy, Polarization Microscopy, Video Middle Aged Monitoring, Intraoperative Mouth Mucosa - blood supply Predictive Value of Tests Prospective Studies Regional Blood Flow Time Factors Treatment Outcome |
| title | Impact of closed minimal extracorporeal circulation on microvascular tissue perfusion during surgical aortic valve replacement: intravital imaging in a prospective randomized study |
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