Zusammenfassung
Die konventionelle extrakorporale Zirkulation (KEKZ) ist das Standardverfahren bei Herzoperationen mit Hilfe der Herz-Lungen-Maschine (HLM). Die mit KEKZ assoziierten Komplikationen – ausgelöst durch Hämodilution und den Kontakt von Blut mit Luft und Fremdoberflächen – beeinflussen die postoperative Morbidität und Mortalität. Die minimierte extrakorporale Zirkulation (MEKZ) ist eine Variante der EKZ und soll die postoperative Komplikationsrate senken. Einige klinische Studien haben bereits für die MEKZ im Vergleich zur KEKZ postoperativ signifikant geringere Werte hinsichtlich Hämodilution und Transfusionsbedarf gezeigt. Andere Ergebnisse geben Anhalt für die These, dass die MEKZ eine weniger ausgeprägte systemische Inflammationsreaktion erzeugt und gegenüber der KEKZ einen myokardprotektiven Effekt aufweist. Im Hinblick auf die operative Mortalität ergab sich bislang in keiner Studie ein signifikanter Vorteil für die MEKZ.
Die vorliegenden Ergebnisse machen die MEKZ zu einer interessanten Perfusionsalternative bevorzugt bei aortokoronaren Bypassoperationen. Insbesondere spezielle Patientenkollektive mit Notwendigkeit zu minimierter Hämodilution (z. B. bei Anämie, Thrombozytopenie, Lebersynthesedefekt oder Patienten, die den Zeugen Jehovas angehören) können von der Verwendung der MEKZ profitieren.
Da die aktuelle Studienlage jedoch nur sehr wenige Berichte der Evidenzklasse 1 oder 2 umfasst, sind weiterführende Untersuchungen nötig, um den tatsächlichen Stellenwert der MEKZ nach EBM-Kriterien beurteilen zu können.
Abstract
Conventional extracorporeal circulation (CECC) is the standard perfusion technique in cardiac surgery, but it causes complications (e.g., blood coagulation disorder and systemic inflammation), which increase postoperative morbidity and mortality.
In recent years, minimal extracorporeal circulation (MECC) has been shown to minimize the frequency of postoperative complications. Some clinical studies have reported significantly lower hemodilution and transfusion requirements using MECC instead of CECC. Further data suggest that the use of MECC reduces the grade of postoperative systemic inflammation and supports myocardial protection. All MECC studies, thus far, have failed to prove a significant decrease in mortality.
The present results show that MECC is an interesting perfusion alternative especially in coronary artery bypass graft surgery. Particularly patients requiring low hemodilution (e.g., with anemia, thrombocytopenia, liver dysfunction or Jehovah’s Witnesses) can benefit from the MECC technique.
Since only a few studies reach evidence level 1 or 2, further investigation of the MECC systems and their effects on the patients’ outcome is necessary.
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Assmann, A., Feindt, P. Minimierte extrakorporale Zirkulation. Z Herz- Thorax- Gefäßchir 23, 229–234 (2009). https://doi.org/10.1007/s00398-009-0731-z
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DOI: https://doi.org/10.1007/s00398-009-0731-z
Schlüsselwörter
- Herzchirurgie
- Aortokoronare Bypassoperation
- (Minimierte) extrakorporale Zirkulation
- Herz-Lungen-Maschine
- Komplikationen
- Systemische Inflammation
- Hämodilution