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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
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
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.