Adult cardiac surgery outcomes: role of the pump type

Objective: This study was carried out to evaluate whether the type of pump used for cardiopulmonary bypass (CPB; roller vs. centrifugal) can affect mo rtality or the neurological outcomes of adult cardiac surgery patients. Met hods: Between 1994 and June 1999, 4000 consecutive patients underwent coron ary 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 a nd intraoperative risk factors for perioperative death, permanent neurologi cal deficit and coma were assessed using univariate and multivariate analys es. Results: The overall in-hospital mortality rate was 2.2% (88/4000), per manent neurological deficit occurred in 2.0% (81/4000) of patients, and com a 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 h and, patients who underwent surgery with centrifugal pumps had lower perman ent neurological deficit (34/2213, (1.5%) vs. 47/1787 (2.6%); P = 0.020) an d coma (20/2213 (0.9%) vs. 32/1787 (1.8%); P = 0.020) rates than patients o perated with roller pumps, Multivariate analysis showed CPB time, previous TLA and age as risk factors for permanent neurological deficit, while centr ifugal pump use emerged as protective. Multivariate risk factors for coma w ere CPB time, previous vascular surgery and age, while centrifugal pump use was protective. Conclusions: Centrifugal pump use is associated with a red uced rate of major neurological complications in adult cardiac surgery, alt hough this is not paralleled by a decrease in in-hospital mortality. (C) 20 00 Elsevier Science B.V. All rights reserved.