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Myocardial protection by simple systemic hypothermia without aortic occlusion
A W Susilo1, A Rocher, R Mohan
1Department of Cardiovascular Surgery, St. Jan Hospital, Brugge, Belgium.
Summary
Systemic hypothermia without cardioplegia safely protects the heart during coronary artery bypass grafting. This method is effective, especially when chemical cardioplegia is contraindicated, offering rapid revascularization for ischemic zones.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Coronary artery bypass grafting (CABG) often involves myocardial protection strategies.
- Chemical cardioplegia and aortic cross-clamping are standard but carry risks.
- Alternative methods for myocardial protection are continuously explored.
Purpose of the Study:
- To evaluate the efficacy and safety of systemic hypothermia alone for myocardial protection during CABG.
- To assess outcomes in patients undergoing CABG with this hypothermia-based strategy.
Main Methods:
- Systemic hypothermia (25-28°C) was employed in 908 CABG patients without chemical cardioplegia.
- Coronary artery flow was interrupted only during distal anastomosis grafting.
- Perfusion pressure, hematocrit, pCO2, and pH were monitored; alpha-stat principle was followed.
Main Results:
- Low rates of perioperative myocardial infarction (3%) and death from left ventricular failure (0.4%) were observed.
- Minimal need for intra-aortic balloon pump (1%) or inotropic support (3.8%).
- Effective in patients with pre-existing myocardial infarction (61.9%), unstable angina (44%), or severe coronary lesions (14%).
Conclusions:
- Systemic hypothermia alone provides safe and effective myocardial protection during CABG.
- This technique is a viable alternative, particularly when cardioplegia is contraindicated.
- It facilitates rapid revascularization of ischemic myocardial regions.