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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 October;39(5):599-607

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Tepid systemic perfusion and intermittent isothermic blood cardioplegia in coronary surgery

Luciani N., Martinelli L., Gaudino M., Alessandrini F., Glieca F., Possati G.

From the Department of Cardiac Surgery and of Anaesthesiology Catholic University, Rome, Italy


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Background. To eval­u­ate ­the safe­ty ­and effec­tive­ness of tep­id per­fu­sion ­and iso­ther­mic ­blood car­di­o­ple­gia in cor­o­nary sur­gery.
Methods. We stud­ied 200 ­patients under­go­ing myo­car­dial revas­cu­lar­iza­tion: 100 pro­ce­dures ­were per­formed ­with mod­er­ate system­ic hypo­ther­mia (28°C) ­and ­cold crys­tal­loid car­di­o­ple­gia (4°C); ­the oth­er 100 ­patients ­received tep­id system­ic per­fu­sion (TP) (34°C) ­and inter­mit­tent ­blood car­di­o­ple­gia at ­the ­same tem­per­a­ture accord­ing to ­the min­i­car­di­o­ple­gia tech­nique (Group 2). The ­two ­groups ­were com­par­able with ­regards to ­age, ­extent of dis­ease, pre­op­er­a­tive ­left ven­tric­u­lar func­tion ­and ­extra-cor­po­real cir­cu­la­tion (­ECC) ­time.
Results. In ­the tep­id ­group we ­observed a high­er inci­dence of spon­ta­ne­ous resump­tion of car­diac ­rhythm at ­cross-­clamp remov­al com­pared to ­the hypo­ther­mic ­group (93% vs 34%; p<0.001). No dif­fer­ence ­was ­found in car­diac ­index at spec­i­fied inter­vals, myo­car­dial ­enzymes, ­inotrope require­ments, arrhyth­mi­as, ­need ­for vas­o­pres­sors ­and ­postoper­a­tive ­blood ­loss. Fluid bal­ance at ­the ­end of ­ECC ­was sig­nif­i­cant­ly low­er in ­the tep­id ­group (343±635 ml vs 883±925 ml; p<0.001). Hospital mor­tal­ity ­and mor­bid­ity ­were ­the ­same in ­the ­two ­groups.
Conclusions. Our ­data sug­gest ­that TP ­and iso­ther­mic ­blood car­di­o­ple­gia rep­re­sent a sim­ple, ­safe ­and effec­tive meth­od of system­ic ­and myo­car­dial pro­tec­tion ­which ­may be an alter­na­tive to tra­di­tion­al hypo­ther­mia.

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