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Published on: March 27, 2018
Cardioprotective effects of acute normovolemic hemodilution in patients undergoing coronary artery bypass surgery
Marc Licker1, Christoph Ellenberger, Jorge Sierra
1Department of Anesthesiology, Pharmacology, and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland. marc-joseph.licker@hcuge.ch
Insights
Lowering blood viscosity with acute normovolemic hemodilution (ANH) before coronary artery bypass surgery (CABG) significantly reduced myocardial injury markers. This technique offers additional cardiac protection beyond standard methods.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) surgery carries risks of myocardial injury.
- Standard myocardial preservation techniques are employed, but further cardioprotection is sought.
Purpose of the Study:
- To investigate if acute normovolemic hemodilution (ANH) provides additional cardioprotection during CABG.
- To assess the impact of reduced blood viscosity on myocardial injury.
Main Methods:
- Prospective, randomized controlled trial involving patients undergoing elective CABG.
- Patients were randomized to ANH (hematocrit target of 28%) or standard care.
- Outcome measures included cardiac enzyme release, hemodynamics, and cardiac complications.
Main Results:
- ANH group showed significantly lower postoperative troponin I and creatine kinase levels.
- Fewer patients in the ANH group required inotropic support.
- Reduced incidence of atrial fibrillation and conduction blocks was observed in the ANH group.
Conclusions:
- Preoperative ANH enhances cardiac protection in patients undergoing on-pump CABG.
- ANH is an effective adjunct to conventional myocardial preservation strategies.
- Lowering blood viscosity via ANH may mitigate myocardial injury during CABG.
Study Objectives:
We hypothesized that lowering blood viscosity with acute normovolemic hemodilution (ANH) would confer additional cardioprotection in patients undergoing coronary artery bypass surgery (CABG) with aortic cross-clamping.
Design:
In a prospective, randomized controlled trial, we studied the efficacy of ANH in anesthetized patients prior to cardiopulmonary bypass for the prevention of myocardial injuries.
Setting:
Cardiac surgical center in a university hospital.
Patients And Methods:
Patients scheduled to undergo elective CABG entered the study protocol and were randomly allocated to one of two groups: ANH (n = 43 patients) or standard care management (n = 41 patients). In the ANH group, the whole-blood/colloid exchange was aimed to achieve a hematocrit value of 28%. All patients were managed with standard myocardial preservation techniques including cold-blood cardioplegia and anesthetic preconditioning. The outcome measures included the release of myocardial enzymes (plasma troponin I and creatinine phosphokinase), perioperative hemodynamic changes, need for pharmacologic cardiovascular support, and cardiac complications.
Results:
In the hemodilution group, the postoperative release of troponin I (mean peak plasma concentration, 1.4 ng/mL; 95% confidence interval, 1.0 to 1.8) and myocardial fraction of creatine kinase (mean, 29 U/L; 95% confidence interval, 23 to 35) were significantly lower than in the control group (mean, 3.8 ng/mL; 95% confidence interval, 3.2 to 4.5; and 71 U/L; 95% confidence interval, 53 to 89). Requirement for inotropic support was significantly lower in the protocol patients (7 of 41 patients vs 15 of 39 patients), and fewer patients presented with either atrial fibrillation, atrioventricular conduction blockade, or combined disorders (12 of 41 patients vs 26 of 39 patients, p < 0.05).
Conclusions:
In addition to conventional myocardial preservation techniques, preoperative ANH achieved further cardiac protection in patients undergoing on-pump myocardial revascularization.
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