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Updated: May 8, 2026
Normothermic Ex Situ Heart Perfusion in Working Mode: Assessment of Cardiac Function and Metabolism
Published on: January 12, 2019
Hypothermic versus normothermic cardiopulmonary bypass in patients with valvular heart disease
Vladimir V Lomivorotov1, Vladimir A Shmirev1, Sergey M Efremov1
1Department of Anesthesiology and Intensive Care, Research Institute of Circulation Pathology, Novosibirsk, Russia.
Insights
Normothermic cardiopulmonary bypass (CPB) offers comparable cardiac protection to hypothermic CPB in valvular heart disease patients. However, hypothermic CPB may lead to shorter ventilation times, warranting further investigation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiopulmonary Bypass
Background:
- Cardiopulmonary bypass (CPB) is essential for cardiac surgery.
- Maintaining myocardial protection during CPB is critical.
- Hypothermic CPB is traditionally used, but normothermic CPB is an alternative.
Purpose of the Study:
- To compare the effectiveness of normothermic CPB versus hypothermic CPB.
- To assess cardiac protection using cardiac troponin I (cTnI) levels.
- To evaluate clinical outcomes in patients with valvular heart disease.
Main Methods:
- Prospective randomized study at a tertiary cardiothoracic center.
- 140 patients with valvular heart disease undergoing CPB.
- Random allocation to hypothermic (31-32°C) or normothermic (>36°C) CPB.
Main Results:
- No significant difference in cardiac troponin I (cTnI) dynamics between groups.
- Ventilation time was significantly shorter in the hypothermic CPB group (p=0.01).
- No significant differences in inotropic support, ICU/hospital stay, complications, or mortality.
Conclusions:
- Normothermic CPB is as effective as hypothermic CPB for myocardial protection in valvular heart disease surgery, based on cTnI release.
- Shorter ventilation duration observed with hypothermic CPB requires further research.
- Both CPB temperatures provide similar clinical outcomes.
Objective:
The aim of this study was to test the hypothesis that normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic CPB in terms of cardiac protection (cTnI level) and outcome in patients with valvular heart disease.
Design:
Prospective randomized study.
Setting:
A tertiary cardiothoracic referral center.
Participants:
140 patients who had valvular heart disease, with/without coronary artery disease, surgically treated under CPB.
Interventions:
The patients were allocated randomly to undergo either hypothermic (temperature [T], 31 °C-32 °C) or normothermic CPB (T>36 °C).
Measurements And Main Results:
The primary endpoint was the dynamics of troponin I. The secondary endpoints were ventilation time, the need for inotropic support, intensive care unit (ICU) and hospital stay durations, complications, and mortality. There were no significant intergroup differences in dynamics of troponin I. Ventilation time was significantly lower in the hypothermic group (6 (5-9) and 8 (5-12); p = 0.01).
Conclusions:
Normothermic CPB in patients with valvular heart disease was as effective as hypothermic perfusion in terms of myocardial protection after the surgery assessed by cTnI release. The short ventilation duration in patients who underwent hypothermic CPB needs to be confirmed in a future investigation.
