Warm heart surgery: a prospective comparison between normothermic and tepid temperature

Area of Science:

• Cardiovascular Surgery
• Cardiopulmonary Bypass
• Surgical Temperature Management

Background:

• Normothermic core temperature during cardiopulmonary bypass is associated with potential complications.
• The safety and efficacy of mild hypothermia versus normothermia in cardiac surgery require further investigation.

Purpose of the Study:

• To compare the outcomes of normothermic (37°C) versus mild hypothermic (34°C) cardiopulmonary bypass in cardiac surgical patients.
• To evaluate the impact of temperature management on intraoperative and postoperative complications.

Main Methods:

• A prospective randomized study involving 200 consecutive patients undergoing cardiac surgery.
• Patients were assigned to either a normothermic group (37°C) or a mild hypothermic group (34°C).
• Key perioperative parameters, including fluid balance, urine output, blood pressure management, and neurological/renal outcomes, were assessed.

Main Results:

• The normothermic group required significantly more volume (p = 0.001) and had reduced urine output (p = 0.03).
• The normothermic group also experienced more difficulties managing blood pressure and required increased phenylephrine hydrochloride (p = 0.05).
• While not statistically significant, strokes and renal failure requiring dialysis were more frequent in the normothermic group.

Conclusions:

• Normothermic cardiopulmonary bypass (37°C) is associated with increased complications, including fluid management issues and potential renal/neurological events.
• Mild hypothermia (34°C) during cardiopulmonary bypass may preserve cardioprotective effects and offers a potentially safer alternative.
• Mild "drifted/tepid" hypothermic heart surgery could represent a superior and safer surgical approach.