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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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ORIGINAL ARTICLES  CARDIAC SECTION


The Journal of Cardiovascular Surgery 2002 February;43(1):31-6

language: English

Clinical evaluation of normothermic cardiopulmonary bypass and cold cardioplegia

Nappi G., Torella M., Romano G.

From the Depart­ment of Car­diac Sur­gery Second Uni­ver­sity of ­Naples Med­ical ­School ''V. ­Monaldi'' Hos­pital, ­Naples, ­Italy


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Back­ground. To eval­uate the ­validity of nor­mo­thermic car­di­o­pul­mo­nary ­bypass (CPB) asso­ciated ­with top­ical hypo­thermia and ­cold car­di­o­plegia tech­nique.
­Methods. In a clin­ical pros­pec­tive ­trial, a con­sec­u­tive ­series of 100 ­patients, homo­ge­neous for dem­o­graphics, clin­ical and oper­a­tive ­data, under­going cor­o­nary ­artery ­bypass sur­gery ­were ran­dom­ized for hypo­thermic CPB (­rectal tem­per­a­ture 28-32°C ­group A, 50 patients) and nor­mo­thermic CPB (­rectal tem­per­a­ture 35-37°C, ­group B, 50 patients). In ­both ­groups of patients ­cold crys­tal­loid car­di­o­plegic solu­tion and top­ical hypo­thermia was ­used.
­Results. ­During CPB ­group B patients had ­lower ­systemic vas­cular resis­tance (p=0.0001); ­they ­needed a sig­nif­i­cant (p=0.0001) ­increase in vas­o­cos­tric­tive. At the ­removal of ­aortic ­cross-­clamp, a spon­ta­neous ­sinus ­rhythm ­resumed in 48% of patients in ­group A and in 95% of ­group B patients (p=0.001). To dis­con­nect CPB, vas­o­con­stric­tive ­drugs ­were ­used in 10% of patients in ­group B and in ­none of patients in ­group A (p=0.0001); vasod­i­lating ­drugs ­were ­infused in 96% of patients in ­group A and in 40% of patients in ­group B (p=0.0001). In the imme­diate post­op­er­a­tive ­period, pos­i­tive ­inotropic ­agents ­were ­used in 67% of patients in ­group A and in 22% of patients in ­group B (p= 0.0003); ­group B patients ­showed a ­more phys­io­log­ical ­rewarming, ­reduced ­periods of mechan­ical ven­ti­la­tion and an ­easier reg­u­la­tion of the ­volemia.
Con­clu­sions. In our clin­ical expe­ri­ence the tech­nique of “­cold ­heart and ­warm ­body” ­proved to be ­safe and effec­tive in sim­pli­fying sur­gical pro­ce­dures and facil­i­tating post­op­er­a­tive man­age­ment.

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