IntroductionVacuum assisted venous drainage (VAVD) is widely adopted in minimally invasive cardiac surgery. VAVD enables the advantage of using smaller cannulae in a reduced surgical field while allowing satisfactory drainage and pump flow. The production of gaseous micro-emboli is a recognized risk associated with VAVD, however no difference in clinical endpoints have been reported between patients operated on with gravity venous drainage (GVD) or with VAVD. Due to the paucity of data on selected surgical populations, we sought to evaluate the early outcomes of patients undergoing isolated aortic valve replacement using VAVD or GVD.MethodsData on 521 patients between 09/2016 and 09/2022 were retrieved from our internal database. Patients were divided into two groups according to use VAVD or GVD. A propensity match analysis was performed to account for difference between the two groups.ResultsThe propensity match provided two well balanced cohorts with 129 patients each. A minimally invasive access was used in 97% of the cases in VAVD group vs 98% in GVD group ( p = .68). Mean cardiopulmonary by-pass (CPB) time was 71 vs 73 min ( p = .74), respectively. There was no difference in lactates peak ( p = .19) and urine output during CPB ( p = .74). We registered two in-hospital deaths in VAVD cohort (1.6%) vs. no mortality in GVD group ( p = .5). Postoperative cerebral stroke occurred in 1 patient in GVD cohort vs. 0 in VAVD ( p = 1). Severe postoperative acute kidney injury complicated the course in 16 patients in GVD group and in 5 patients who had VAVD ( p = .012). VAVD was associated with a higher number of patients with elevated postoperative AST ( p = .07) and Troponin I ( p = .01) values.ConclusionsThe use of VAVD during isolated aortic valve replacement was not associated with increased risks of postoperative complications and in-hospital mortality with results that were at least similar to those registered in a matched cohort of patients operated on with GVD.

中文翻译：

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主动脉瓣手术中的真空辅助和重力静脉引流：倾向匹配研究

简介真空辅助静脉引流（VAVD）广泛应用于微创心脏手术。VAVD 具有在缩小手术区域中使用较小插管的优点，同时允许令人满意的引流和泵流量。气态微栓子的产生是与 VAVD 相关的公认风险，但重力静脉引流 (GVD) 或 VAVD 手术患者之间的临床终点没有差异的报告。由于缺乏选定手术人群的数据，我们试图评估使用 VAVD 或 GVD 进行孤立主动脉瓣置换术的患者的早期结果。方法从我们的内部数据库检索 2016 年 9 月至 2022 年 9 月期间 521 名患者的数据。根据使用VAVD或GVD将患者分为两组。进行倾向匹配分析以解释两组之间的差异。结果倾向匹配提供了两个平衡良好的队列，每个队列有 129 名患者。VAVD 组中 97% 的病例使用了微创手术，而 GVD 组中这一比例为 98% (p = .68)。平均体外循环 (CPB) 时间分别为 71 分钟和 73 分钟 (p = .74)。CPB 期间乳酸峰值 (p = .19) 和尿量 (p = .74) 没有差异。我们记录了 VAVD 组中两例院内死亡 (1.6%)，而 GVD 组中没有死亡 (p = .5)。GVD 队列中 1 名患者发生术后脑卒中，而 VAVD 队列中 0 名患者发生术后脑卒中 (p = 1)。GVD 组中的 16 名患者和 VAVD 组中的 5 名患者中，严重的术后急性肾损伤使病程复杂化 (p = .012)。VAVD 与术后 AST ( p = .07) 和肌钙蛋白 I ( p = .01) 值升高的患者数量较多相关。 结论 在离体主动脉瓣置换术期间使用 VAVD 与术后并发症风险增加无关，并且- 医院死亡率的结果至少与接受 GVD 手术的匹配患者队列中登记的结果相似。