Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?

Author:

Likosky Donald S.,Baker Robert A.,Newland Richard F.,Paugh Theron A.,Dickinson Timothy A.,Fitzgerald David,Goldberg Joshua B.,Mellas Nicholas B.,Merry Alan F.,Myles Paul S.,Paone Gaetano,Shann Kenneth G.,Ottens Jane,Willcox Timothy W.,

Abstract

Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as “conventional,” inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were “all-but-cannula” biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term “conventional bypass” may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients.

Publisher

EDP Sciences

Subject

Cardiology and Cardiovascular Medicine,Health Professions (miscellaneous),Medicine (miscellaneous)

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Regional anesthesia in coronary artery bypass grafting: a narrative review;Regional Anesthesia and Acute Pain Management;2023-11-23

2. Adult Clinical Perfusion Practice Survey: 2020 results;The Journal of ExtraCorporeal Technology;2023-03

3. Perfusion standards and guidelines;Cardiopulmonary Bypass;2023

4. The Effect of Standardizing Autologous Prime Techniques in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass;The Journal of ExtraCorporeal Technology;2019-12

5. Data, data, data…;The Journal of ExtraCorporeal Technology;2018-12

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