METHODS: A retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS).
RESULTS: There were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different.
CONCLUSIONS: Our analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.
方法:对2022年6月至10月接受CPB的连续成年患者进行回顾性分析,比较WB或GB组。主要结局是手术死亡或主要发病率的复合。次要终点包括CPB的输血要求,患者降温和升温速率,和病例完成时的血管活性-正性肌力评分(VIS)。使用P控制图来监测复合结局的每周发生率。进行子分析以评估由胸外科医师协会(STS)索引的心脏手术病例的主要结局。
结果:纳入167例患者进行分析;87例(52.1%)采用WB系统进行CPB,80例(47.9%)采用GB系统进行CPB。GB手术受试者较年轻(p=0.01),经历了更长的CPB时间(p=.034),并且更可能接受胸部移植或主动脉手术(p=0.015)。WB和GB组的手术死亡率或主要发病率的复合结局分别为29.9%和24%。分别(p=.372)。P控制图显示,在世界银行实践期间,每周平均发生率为30%,随着GB的实践,这一比例降至24%。在106例STS索引的心脏手术病例中,在我们的GB过渡后,平均复合结局发生率从19%下降至6%.此外,冷却,病例完成时,以患者BSA和VIS为指标的加温率无显著差异.
结论:我们的分析表明,在我们的实践中,从WB到GB加热器-冷却器技术的安全过渡。这项早期分析表明,可以安全地采用GB加热器冷却器来减轻心脏外科手术患者非结核分枝杆菌感染的风险。