Clinical study of normothermic cardiopulmonary bypass in 100 patients with coronary artery disease
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Published on: March 23, 2018
1Department of Cardiovascular Surgery, Hôpital Bichat, Paris, France.
Insights
This study demonstrates that normothermic cardiopulmonary bypass (CPB) can be performed safely with significantly lower volumes of cardioplegia and crystalloid solutions, and less frequent use of phenylephrine, compared to other established protocols.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiopulmonary Bypass Techniques
Background:
- Normothermic cardiopulmonary bypass (CPB) is standard practice for cardiac operations since 1987.
- Myocardial protection during normothermic CPB is achieved via cold intermittent antegrade blood cardioplegia, no topical cooling, and a terminal
- A previous study suggested normothermic CPB requires large fluid volumes and frequent vasopressor use.
Purpose of the Study:
- To establish a routine technique for cold heart-warm body bypass.
- To evaluate the fluid and pharmacologic requirements during normothermic CPB.
Main Methods:
- A clinical study involving 100 consecutive patients with coronary artery disease undergoing normothermic CPB.
- Comparison of cardioplegia and crystalloid volumes, and phenylephrine use, against data from the Toronto group.
Main Results:
- Total cardioplegia volume: 1,946 mL (vs. 4,700 mL).
- Crystalloid volume loading needed in 26% of patients (vs. 3,650 mL total).
- Phenylephrine used in 16% of patients (vs. 88%).
Conclusions:
- Normothermic CPB can be performed with significantly reduced cardioplegia and crystalloid volumes.
- The need for vasopressors like phenylephrine is substantially lower than previously reported.
- This technique offers a more efficient approach to myocardial protection during cardiac surgery.
Abstract:
During normothermic cardiopulmonary bypass (CPB), the body temperature is maintained at 37 degrees C. Since 1987, it has been our standard practice to use normothermic CPB in our patients undergoing a cardiac operation, and our experience now consists of more than 3,000 consecutive patients. Myocardial protection is achieved through the combination of cold intermittent antegrade blood cardioplegia, no topical cooling, and a terminal "hot shot" of blood cardioplegia. We disagree with the stance of the Toronto group that normothermic CPB requires the administration of large volumes of cardioplegic and crystalloid solutions and the frequent use of phenylephrine hydrochloride to ensure a low systemic vascular resistance. To establish a routine technique of cold heartwarm body bypass, we conducted a clinical study in 100 consecutive patients with coronary artery disease. We found that the total cardioplegia volume needed in our patients was 1,946 +/- 257 mL, versus 4,700 +/- 1,900 mL in the Toronto study, and an additional crystalloid volume loading of 400 +/- 141 mL during CPB was needed in 26% of our patients, versus a total volume of 3,650 +/- 800 mL in the Toronto series. Phenylephrine (250 micrograms) was used in 16% of our patients, versus 88% of the patients in the Toronto study (mean dose, 1.3 mg). During normothermic CPB, the mean radial arterial pressure was 57.3 +/- 9.4 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
