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Warm heart surgery eliminates diaphragmatic paralysis

M Maccherini1, G Davoli, G Sani

  • 1Istituto di Chirurgia Toracica e Cardiovascolare, Università Degli Studi di Siena, Siena, Italy.

Journal of Cardiac Surgery
|May 1, 1995
PubMed
Summary

Warm blood cardioplegia during normothermic cardiopulmonary bypass (CPB) reduces diaphragmatic injury compared to cold methods. This warm heart surgery approach avoids phrenic nerve injury associated with topical cooling and hypothermia.

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Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Medical Technology

Background:

  • Traditional myocardial protection often involves hypothermic cardiopulmonary bypass (CPB) with cold blood cardioplegia and topical ice slush.
  • This hypothermic approach has been associated with complications such as diaphragmatic paralysis and pleural effusions.

Purpose of the Study:

  • To compare the incidence of diaphragmatic injury and related complications between normothermic and hypothermic cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG).
  • To evaluate the safety and efficacy of a novel warm blood cardioplegia technique.

Main Methods:

  • A retrospective study comparing 50 patients undergoing elective CABG with normothermic CPB and warm blood cardioplegia to 50 patients who received hypothermic CPB with cold cardioplegia and topical ice slush.

Related Experiment Videos

  • Postoperative chest X-rays were analyzed to assess diaphragmatic function and pleural abnormalities.

    • Main Results:

    • The hypothermic group showed a statistically significant increase in transitory diaphragmatic paralysis, pleural effusions, and thoracentesis compared to the normothermic group.
    • No diaphragmatic injury was observed in the normothermic CPB group.

    Conclusions:

    • Topical cooling with ice slush during hypothermic CPB is linked to phrenic nerve injury and subsequent diaphragmatic dysfunction.
    • Warm heart surgery utilizing normothermic CPB and continuous warm blood cardioplegia is a safer alternative, significantly reducing the risk of diaphragmatic injury.