ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2001 June;42(3):333-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.