Cardiopulmonary bypass techniques and clinical outcomes in Beijing Fuwai Hospital: a brief clinical review.

The purpose of this study is to briefly summarize cardiopulmonary bypass (CPB) techniques and clinical outcomes in Beijing Fuwai Hospital. This article introduces routine CPB techniques in Fuwai Hospital, including CPB instruments, circuit setup, priming, conventional CPB management, myocardial protection, deep hypothermic circulatory arrest, ultrafiltration, autologous cell saver blood transfusion, and extracorporeal membrane oxygenation (ECMO). Clinical outcomes and further improvements of CPB management are also discussed. In 2008, 7,607 cases of cardiac surgery were performed in Fuwai Hospital, including congenital heart disease (48.33%), coronary artery disease (23.30%), rheumatic heart disease (19.45%), blood vessel disease (5.90%), reoperative surgery (1.70%), and other diseases (1.33%). The use of off-pump coronary artery bypass grafting (CABG) in isolated CABG was >50%. Thirty-eight cases of heart transplantation were also included. Total operative mortality in 2008 was 1.2%. Average postoperative stay was 9.5 days. CPB time was 70% of the patients, and aortic cross-clamping time was 50% of the cases. The self-recovery rate in the blood cardioplegia group (69.50%) was lower than the crystalloid cardioplegia group (97.40%). Thirtyfive patients underwent cardiac surgery, and one patient from the cardiac internal medicine wards required ECMO support. Twentyseven patients (75%, mean support time: 123.654.1 hours) were weaned off ECMO successfully and discharged without severe complications. In conclusion, clinical CPB protocol used in Beijing Fuwai Hospital is a safe, simple, and conventional CPB management system that is suitable for practical clinical application in China. Further optimization is still needed to improve perfusion quality. ASAIO Journal 2011; 57:414‐420. Beijing Fuwai Hospital was founded in 1956 and also named Fuwai Hospital and Cardiovascular Institute, which is an affiliated cardiovascular-specific institution of Peking Union Medical College and Chinese Academy of Medical Sciences. With the rapid increase in economic growth and public transport development, an increasing number of patients from all over the country come to Fuwai Hospital for operations. Being the largest heart center in China, the number of operations in the cardiovascular surgery department reached 7,606 in 2008, despite the disastrous Wenchuan earthquake and the exceptional Beijing Olympic Games. After the development of cardiovascular surgery, cardiopulmonary bypass (CPB) technology gradually evolved into our own clinical routine as a production line of the “perfusion factory.” It has been demonstrated that our routine management of CPB can provide a safe, simple, and convenient CPB technique in supporting modern cardiac surgery that is suitable for practical clinical application in China. Regardless of the increasing numbers of “off-pump” coronary artery bypass grafting (CABG) and interventional therapy, CPB technique is still an essential assisting method for open heart surgery. The potentially detrimental side effects of CPB are directly associated with perioperative morbidity and mortality in postoperative cardiac surgery patients. Therefore, clinical routine CPB management should be given increased attention to minimize the detrimental effects of CPB. This article summarizes our routine clinical CPB techniques in Fuwai Hospital in 2008 and is intended to share our perfusion techniques, clinical outcomes, and intended future technical improvements.