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

World Journal of Clinical Urology 2014年第2期3卷 127-133页

作者： Alessandro Antonelli Gianluigi Bisleri irene mittino Annalisa Moggi Claudio Muneretto Sergio Cosciani Cunico Claudio Simeone Chair and Division of Urology Spedali Civili HospitalUniversity of Brescia25127 BresciaItaly Department of Cardiac Surgery University of BresciaBresciaItaly

AIM: To compare a modified technique preserving brain circulation during cardiopulmonary by-pass(CPB) for radical nephrectomy and caval thrombectomy, to the standard ***: 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 n

关键词： Renal carcinoma Vena cava thrombosis Cardiopulmonary bypass Cerebral perfusion Circulatory arrest

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