Adult cardiac surgery outcomes: role of the pump type

• Published in: European journal of cardio-thoracic surgery 2000-11, Vol.18 (5), p.575-582
• Main Authors: Parolari, A., Alamanni, F., Naliato, M., Spirito, R., Franzè, V., Pompilio, G., Agrifoglio, M., Biglioli, P.
• Format: Article
• Language: English
• Subjects: Aged; Analysis of Variance; Biological and medical sciences; Brain Injuries - etiology; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - instrumentation; Cardiopulmonary Bypass - mortality; Centrifugal pump; Coma - etiology; Coronary Artery Bypass; Female; Heart Valve Prosthesis Implantation; Hospital Mortality; Humans; Ischemic Attack, Transient - complications; Logistic Models; Male; Medical sciences; Middle Aged; Mortality; Neurological outcome; Retrospective Studies; Risk Factors; Roller pump; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(00)00552-2

Objective: This study was carried out to evaluate whether the type of pump used for cardiopulmonary bypass (CPB; roller vs. centrifugal) can affect mortality or the neurological outcomes of adult cardiac surgery patients. Methods: Between 1994 and June 1999, 4000 consecutive patients underwent coronary and/or valve surgery at our hospital; of these, 2213 (55.3%) underwent surgery with centrifugal pump use, while 1787 (44.7%) were operated on with a roller pump. The effect of the type of the pump and of 36 preoperative and intraoperative risk factors for perioperative death, permanent neurological deficit and coma were assessed using univariate and multivariate analyses. Results: The overall in-hospital mortality rate was 2.2% (88/4000), permanent neurological deficit occurred in 2.0% (81/4000) of patients, and coma in 1.3% (52/4000). There was no difference in hospital mortality between patients operated with the use of centrifugal pumps and those operated with roller pumps (50/2213 (2.3%) vs. 38/1787 (2.1%); P=0.86). On the other hand, patients who underwent surgery with centrifugal pumps had lower permanent neurological deficit (34/2213, (1.5%) vs. 47/1787 (2.6%); P=0.020) and coma (20/2213 (0.9%) vs. 32/1787 (1.8%); P=0.020) rates than patients operated with roller pumps. Multivariate analysis showed CPB time, previous TIA and age as risk factors for permanent neurological deficit, while centrifugal pump use emerged as protective. Multivariate risk factors for coma were CPB time, previous vascular surgery and age, while centrifugal pump use was protective. Conclusions: Centrifugal pump use is associated with a reduced rate of major neurological complications in adult cardiac surgery, although this is not paralleled by a decrease in in-hospital mortality.