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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2001 Giugno;42(3):333-8
Postoperative myocardial ischemia in thoracic aortic aneurysms
Sasaki S., Yasuda K., Nanzaki S. *, Kobayashi S. *, Morimoto Y. *, Gando S. *, Kemmotsu O. *
From the Department of Cardiovascular Surgery
*Division of Intensive Care Hokkaido University Hospital, Sapporo, Japan
Background. To determine the incidence and predictors of postoperative myocardial ischemia in non-coronary risk patients undergoing surgery for thoracic aortic aneurysms.
Methods. Design: a prospective, observational study. Setting: a general intensive care unit in a university hospital. Participants: twenty patients without ischemic heart disease, scheduled for elective surgical repair of thoracic or thoracoabdominal aortic aneurysms. Interventions: all patients underwent aortic replacement with prosthetic graft and routine postoperative care. Patients who developed myocardial ischemia received an infusion of coronary vasodilators.
Results. ECG episodes of myocardial ischemia were defined as reversible ST-segment changes of either >1 mm of depression or >2 mm of elevation at the J point. All patients survived operation. Eleven patients (ischemia group) developed myocardial ischemia, and 9 patients did not (non-ischemia group). These episodes were transient in 8 cases, but lasted longer than 3 days in 3 cases. In univariate analysis of perioperative factors between the two groups, the use of total cardiopulmonary bypass (p<0.01), the cardiac index at ICU admission (p<0.05), and the incidence of pre-existent hypertension (p<0.05) were significantly different. Multiple regression analysis identified the use of total cardiopulmonary bypass as the only predictor of myocardial ischemia.
Conclusions. The use of total cardiopulmonary bypass is predictive of perioperative myocardial ischemia in surgery for thoracic aortic aneurysms, probably due to the production of proinflammatory cytokines by systemic ischemia and reperfusion. Prophylactic use of coronary vasodilators may be validated in these cases.