Cargando…
Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis
OBJECTIVE: A meta-analysis of randomized controlled trials was performed to compare the effects of miniaturized extracorporeal circulation (MECC) and conventional extracorporeal circulation (CECC) on morbidity and mortality rates after cardiac surgery. METHODS: A comprehensive literature search was...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390465/ https://www.ncbi.nlm.nih.gov/pubmed/36004169 http://dx.doi.org/10.1016/j.xjon.2021.09.037 |
_version_ | 1784770660521738240 |
---|---|
author | Cheng, Timothy Barve, Rajas Cheng, Yeu Wah Michael Ravendren, Andrew Ahmed, Amna Toh, Steven Goulden, Christopher J. Harky, Amer |
author_facet | Cheng, Timothy Barve, Rajas Cheng, Yeu Wah Michael Ravendren, Andrew Ahmed, Amna Toh, Steven Goulden, Christopher J. Harky, Amer |
author_sort | Cheng, Timothy |
collection | PubMed |
description | OBJECTIVE: A meta-analysis of randomized controlled trials was performed to compare the effects of miniaturized extracorporeal circulation (MECC) and conventional extracorporeal circulation (CECC) on morbidity and mortality rates after cardiac surgery. METHODS: A comprehensive literature search was conducted using Ovid, PubMed, Medline, EMBASE, and the Cochrane databases. Randomized controlled trials from the year 2000 with n > 40 patients were considered. Key search terms included variations of “mini,” “cardiopulmonary,” “bypass,” “extracorporeal,” “perfusion,” and “circuit.” Studies were assessed for bias using the Cochrane Risk of Bias tool. The primary outcomes were postoperative mortality and stroke. Secondary outcomes included arrhythmia, myocardial infarction, renal failure, blood loss, and a composite outcome comprised of mortality, stroke, myocardial infarction and renal failure. Duration of intensive care unit, and hospital stay was also recorded. RESULTS: The 42 studies eligible for this study included a total of 2154 patients who underwent CECC and 2196 patients who underwent MECC. There were no significant differences in any preoperative or demographic characteristics. Compared with CECC, MECC did not reduce the incidence of mortality, stroke, myocardial infarction, and renal failure but did significantly decrease the composite of these outcomes (odds ratio, 0.64; 95% confidence interval [CI], 0.50-0.81; P = .0002). MECC was also associated with reductions in arrhythmia (odds ratio, 0.67; 95% CI, 0.54-0.83; P = .0003), blood loss (mean difference [MD], –96.37 mL; 95% CI, –152.70 to –40.05 mL; P = .0008), hospital stay (MD, –0.70 days; 95% CI, –1.21 to –0.20 days; P = .006), and intensive care unit stay (MD, –2.27 hours; 95% CI, –3.03 to –1.50 hours; P < .001). CONCLUSIONS: MECC demonstrates clinical benefits compared with CECC. Further studies are required to perform a cost–utility analysis and to assess the long-term outcomes of MECC. These should use standardized definitions of endpoints such as mortality and renal failure to reduce inconsistency in outcome reporting. |
format | Online Article Text |
id | pubmed-9390465 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-93904652022-08-23 Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis Cheng, Timothy Barve, Rajas Cheng, Yeu Wah Michael Ravendren, Andrew Ahmed, Amna Toh, Steven Goulden, Christopher J. Harky, Amer JTCVS Open Adult: Perioperative Management OBJECTIVE: A meta-analysis of randomized controlled trials was performed to compare the effects of miniaturized extracorporeal circulation (MECC) and conventional extracorporeal circulation (CECC) on morbidity and mortality rates after cardiac surgery. METHODS: A comprehensive literature search was conducted using Ovid, PubMed, Medline, EMBASE, and the Cochrane databases. Randomized controlled trials from the year 2000 with n > 40 patients were considered. Key search terms included variations of “mini,” “cardiopulmonary,” “bypass,” “extracorporeal,” “perfusion,” and “circuit.” Studies were assessed for bias using the Cochrane Risk of Bias tool. The primary outcomes were postoperative mortality and stroke. Secondary outcomes included arrhythmia, myocardial infarction, renal failure, blood loss, and a composite outcome comprised of mortality, stroke, myocardial infarction and renal failure. Duration of intensive care unit, and hospital stay was also recorded. RESULTS: The 42 studies eligible for this study included a total of 2154 patients who underwent CECC and 2196 patients who underwent MECC. There were no significant differences in any preoperative or demographic characteristics. Compared with CECC, MECC did not reduce the incidence of mortality, stroke, myocardial infarction, and renal failure but did significantly decrease the composite of these outcomes (odds ratio, 0.64; 95% confidence interval [CI], 0.50-0.81; P = .0002). MECC was also associated with reductions in arrhythmia (odds ratio, 0.67; 95% CI, 0.54-0.83; P = .0003), blood loss (mean difference [MD], –96.37 mL; 95% CI, –152.70 to –40.05 mL; P = .0008), hospital stay (MD, –0.70 days; 95% CI, –1.21 to –0.20 days; P = .006), and intensive care unit stay (MD, –2.27 hours; 95% CI, –3.03 to –1.50 hours; P < .001). CONCLUSIONS: MECC demonstrates clinical benefits compared with CECC. Further studies are required to perform a cost–utility analysis and to assess the long-term outcomes of MECC. These should use standardized definitions of endpoints such as mortality and renal failure to reduce inconsistency in outcome reporting. Elsevier 2021-10-01 /pmc/articles/PMC9390465/ /pubmed/36004169 http://dx.doi.org/10.1016/j.xjon.2021.09.037 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Adult: Perioperative Management Cheng, Timothy Barve, Rajas Cheng, Yeu Wah Michael Ravendren, Andrew Ahmed, Amna Toh, Steven Goulden, Christopher J. Harky, Amer Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title | Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title_full | Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title_fullStr | Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title_full_unstemmed | Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title_short | Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis |
title_sort | conventional versus miniaturized cardiopulmonary bypass: a systematic review and meta-analysis |
topic | Adult: Perioperative Management |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390465/ https://www.ncbi.nlm.nih.gov/pubmed/36004169 http://dx.doi.org/10.1016/j.xjon.2021.09.037 |
work_keys_str_mv | AT chengtimothy conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT barverajas conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT chengyeuwahmichael conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT ravendrenandrew conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT ahmedamna conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT tohsteven conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT gouldenchristopherj conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis AT harkyamer conventionalversusminiaturizedcardiopulmonarybypassasystematicreviewandmetaanalysis |