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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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