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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2005 October;18(5):277-82
Effect of cardiopulmonar bypass on coronary circulation
Tamayo E., Alvarez J., Soria S., Rodríguez R., Gómez J. I., Di Stefano S., Florez S
Aim. Reduction of coronary blood flow (CBF) has been observed during re-perfusion of the previously ischemic myocardium, in animals as well as in patients after coronary angioplasty or phamarcological thrombolysis. This phenomenon is known as no reflow. The aim is to verify the existence of no reflow in patients, after myocardial ischemia by extracorporeal circulation.
Methods. The subject of study were nine patients (3 females and 6 males) with ejection fraction >0,5 treated with aortocoronary bypass, in which complete myocardial revascularization was realized. Arterial systolic, diastolic and mean pressure was determined by intra-arterial catheter. Central venous pressure, pulmonary arterial pressure and cardiac output were determined using Swan Ganz thermodilution catheters. CBF was determined by retrograde thermodilution using Baim catheter. CPP and CVR were measured. Myocardial oxygen consumption (MVO2), oxygen saturation (SaO2) and myocardial oxygen extraction (MO2E) in coronary sinus were determined as metabolic variables. In addition, enzymatic and electrocardiographic analysis were realized. All variables were registered on the following occasions: after anesthesia induction (M1), before aortic cross-clamping (M2), after aortic unclamping (M3), as well as after separation from cardiopulmonary bypass (M4), before sternal closing (M5), during skin closure (M6), when moving to the Intensive Care Unit (M7), again 6 hours later (M8), and finally the next day (M9).
Results. At all moments (M1-M9), the values of hemodynamic, metabolic and gasometric systemic constants remained stable. Electrocardiographic or enzymatic changes that could indicate ischemia or myocardial infarction were not observed. When maintaining CPP without changes, the CBF and CVR also remained without significant variations. SaO2 and MO2E showed no significant variations. Thus the phenomenon of no reflow and alteration of coronary self-regulation did not appear.
Conclusion. With our study model and in the patients enrolled, we did not find any evidence of the fact that extracorporeal circulation produces the phenomenon of no reflow.