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The Journal of Cardiovascular Surgery 2001 October;42(5):587-93

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Beneficial effect of balloon-induced pulsatility on brain oxygenation in hypothermic cardiopulmonary bypass

Hashimoto K., Onoguchi K., Takakura H., Sasaki T., Hachiya T., Oshiumi M., Takeuchi S.

From the Saitama Cardiovascular and Respiratory Center, Department of Cardiovascular Surgery, Saitama-ken, Japan


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Back­ground. Suf­fi­cient O2 ­delivery to ­meet the ­demand is an impor­tant ­factor for pro­tecting the ­brain ­during car­di­o­pul­mo­nary ­bypass (CPB). ­This ­study was ­designed to inves­ti­gate the influ­ences of tem­per­a­ture, pul­sa­tility of ­blood ­flow (intra-­aortic bal­loon ­pump-­induced) and ­flow ­rate ­during CPB on the cere­bral oxy­gen­a­tion.
­Methods. ­Patients ­were ­divided ­into ­five ­groups. Nor­mo­thermia (36°C): pul­sa­tile (n=8, 2.5 L/min/m2), non­pul­sa­tile (n=12, 2.5 L), and non­pul­sa­tile per­fu­sion (n=12, 2.8 L); hypo­thermia (30°C): pul­sa­tile (n=9, 2.5 L) and non­pul­sa­tile per­fu­sion (n=11, 2.5 L). The ­oxygen sat­u­ra­tion (­SjVO2), lac­tate and CPK-BB ­levels in the jug­ular ­venous ­blood ­were meas­ured.
­Results. In all of the nor­mo­thermic ­groups, the ­SjVO2 ­value ­decreased ­during the CPB (p<0.1-0.01). No remark­able ­change was ­observed in the hypo­thermic ­groups, ­with the excep­tion ­during the ­rewarming ­period in the non­pul­sa­tile ­group. A ­higher ­SjVO2 and a ­lower fre­quency of ­SjVO2 ­values <50% ­were ­observed in the hypo­thermic pul­sa­tile ­group, as com­pared ­with ­those in the nor­mo­thermic ­groups (p<0.05). The ­levels of CPK-BB ­were ­nearly the ­same, how­ever the ­levels of lac­tate ­were ­higher in the nor­mo­thermic pul­sa­tile and non­pul­sa­tile (2.5 L) ­groups (p<0.05).
Con­clu­sions. We con­cluded ­that the hypo­thermic CPB was advan­ta­geous ­over nor­mo­thermic CPB in ­regard to the ­SjVO2 ­levels and lac­tate pro­duc­tion. The ben­e­fi­cial ­effect of intra-­aortic bal­loon ­pump ­assist was ­only ­obtained in the hypo­thermic CPB.

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