Cardiopulmonary bypass with brain perfusion for renal cell carcinoma with caval thrombosis

查看全文 作　　者：Alessandro [1]Antonelli;Gianluigi [2]Bisleri;Irene [1]Mittino;Annalisa [2]Moggi;Claudio [1,2]Muneretto;Sergio Cosciani [1]Cunico;Claudio [1]Simeone 机构地区：[1]Chair and Division of Urology,Spedali Civili Hospital,University of Brescia,25127 Brescia,Italy;[2]Department of Cardiac Surgery,University of Brescia,Brescia,Italy 出　　处：《World Journal of Clinical Urology》索引2014年第3卷第2期,共7页 摘　　要：AIM: To compare a modified technique preserving brain circulation during cardiopulmonary by-pass(CPB) for radical nephrectomy and caval thrombectomy, to the standard technique.METHODS: Retrospective evaluation of an institutional database that collects the data of patients submitted to nephrectomy and removal of caval thrombosis with CPB since 1998. In period between 1998 and 2007, CPB followed a standard technique(group s CPB); then, since 2008, a variation in the perfusional technique was introduced, allowing the anterograde perfusion of brain circulation during circulatory arrest(group CPB + BP) with the aim to reduce the risk of ischemic damage to the brain and also the need of deeper hypothermia. Patients(age, gender, comorbidity) and tumor characteristics(side, histology, staging, level of thrombosis), as well as parameters of CPB(times of CPB, aortic clamping andcirculatory arrest, minimum temperature reached during hypothermia), intra- and perioperative morbidity(complications in general, bleeding, renal and hepatic failure) and mortality were analyzed and compared between 2 groups(s CPB vs CPB + BP)RESULTS: The data of 24 patients, respectively 9 in s CPB group and 15 in CPB + BP group, have been reviewed. No differences in the characteristics of patients and tumors were observed. Only 1(11.1%) and 4(26.0%) of s CPB and CPB + BP patients, respectively, didn't experience any event of complication. In s CPB group were observed 15 events of complication(5 of which Clavien ≥ 3, 33% of the events), for a mean of 1.66 events/patient; 29 events(10 Clavien ≥ 3, 30.3%), in the CPB + BP group, for a mean of 2.1 events/patient. 1(11.1%) and 2(14.2%) deaths occurred, respectively. For patients submitted to CPB + BP, the minimum temperature reached was significantly higher(29.9 ℃ vs 26.4 ℃, P = 0.001), the time of circulatory arrest was longer(17.4 min vs 13.7 min, NS), but the overall time of CPB shorter(76.1 min vs 92.5 min, NS), albeit these latter differences were not statistically significant. No differences in terms of bleeding, impairment of renal function(post-operative Cr > 2.0 mg/d L respectively in 44.4% vs 35.7% of cases, in the two groups, NS) or hepatic insufficiency(post-operative GOT or GPT > 50 U/L respectively in 44.4% and 66.7% of patients, NS) were noted. Average follow-up was 51 mo in patients undergoing a s CPB and 12 mo in the CPB + BP group of patients; at the last follow-up, 7 patients had died of progression of the condition(4 in the first group and 3 in the second group, respectively), 7 were alive in progression and 10 had no evidence of the disease. CONCLUSION: The perfusional technique that maintains brain perfusion during circulatory arrest limits hypothermia and lowers time of CPB, without rising the risk of renal and hepatic injury. 关 键 词：Renal carcinoma Vena cava THROMBOSIS CARDIOPULMONARY BYPASS Cerebral PERFUSION Circulatory ARREST