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[Hormonal regulation during cardiac surgery operations on the "dry" heart]
Insights
Profound hypothermia during heart valve surgery causes temporary changes in stress hormone regulation and the renin-angiotensin-aldosterone system (RAAS). These neurohormonal effects are more significant with cardiopulmonary bypass compared to hypothermal perfusion alone.
Area of Science:
- Cardiovascular Surgery
- Endocrinology
- Neuroendocrinology
Background:
- Heart valve defects often require surgical intervention.
- Hypothermal perfusion and cardiopulmonary bypass are critical techniques in cardiac surgery.
- Understanding the neurohormonal response to these procedures is vital for patient management.
Purpose of the Study:
- To assess the impact of profound hypothermal perfusion during heart valve surgery on key endocrine systems.
- To compare the neurohormonal effects of cardiopulmonary bypass versus hypothermal perfusion alone.
Main Methods:
- Studied 72 patients undergoing heart valve defect surgery under profound hypothermal perfusion.
- Monitored central and peripheral hypophyseo-adrenal regulation.
- Assessed the renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating hormone (TSH) levels.
Main Results:
- Cardiopulmonary bypass with profound hypothermia induced moderate, reversible changes in endocrine parameters.
- Hypophyseo-adrenal activity and RAAS peaked during rewarming, then declined.
- Thyroid-stimulating hormone (TSH) levels decreased significantly post-surgery.
Conclusions:
- Profound hypothermia during heart valve surgery leads to transient neurohormonal alterations.
- Cardiopulmonary bypass surgery demonstrated more significant neurohormonal changes than hypothermal perfusion alone.
- These changes may relate to circulatory arrest and altered peripheral metabolism.
Abstract:
Central and peripheral compartments of hypophyseo-adrenal regulation, the state of renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating functions of hypophysis have been assessed in 72 patients with heart valve defects operated under profound hypothermal perfusion. It has been established that cardiopulmonary bypass surgery with profound hypothermia is accompanied by moderate and reversible changes in the above parameters. The activity of hypophyseo-adrenal system and RAAS reaches the maximum during a warming-up period and then gradually decreases. TSH content considerably decreases in the early postoperative period. Cardiopulmonary bypass surgery with profound hypothermia causes more pronounced changes in neurohormonal regulation than heart valve correction under hypothermal perfusion, which might be associated with blood flow arrest in major vessels causing changes in peripheral metabolic processes.