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Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting
J T Christenson1, J Maurice, F Simonet
1Cardiovascular Unit, Hôpital de la Tour, Meyrin, Geneva.
Insights
Normothermic cardiopulmonary bypass is associated with better outcomes than hypothermic bypass in coronary artery bypass grafting surgery, including reduced myocardial infarction and fewer complications.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Systemic hypothermia during cardiopulmonary bypass is a common practice in cardiac surgery.
- Its impact on perioperative outcomes compared to normothermia requires further investigation.
Purpose of the Study:
- To compare the outcomes of normothermic versus hypothermic cardiopulmonary bypass in patients undergoing primary coronary artery bypass grafting (CABG).
Main Methods:
- A comparative study of 1442 patients undergoing primary CABG.
- Group 1: moderate systemic hypothermia (28°C). Group 2: normothermia (37°C).
- Both groups received cold cardioplegic arrest and local cardiac cooling.
Main Results:
- Normothermic bypass (Group 2) showed a significantly lower incidence of myocardial infarction (0.7% vs 2.0%) and fewer intra-aortic balloon insertions (2.2% vs 4.6%) compared to hypothermic bypass (Group 1).
- Group 2 also had fewer postoperative ventricular arrhythmias, shorter intubation times, and less transient renal failure.
- Mortality rates were similar (3.3% vs 2.6%), but Group 2 required less blood transfusion (1.2 vs 1.1 units).
Conclusions:
- Normothermic cardiopulmonary bypass may offer significant advantages over hypothermic bypass in primary CABG surgery.
- These advantages include reduced myocardial injury, fewer complications, and potentially shorter recovery times.
Abstract:
Normothermic versus hypothermic cardiopulmonary bypass was evaluated in 1442 consecutive patients undergoing primary coronary artery bypass grafting (CABG). Group 1 (n = 545) were operated on in moderate systemic hypothermia (rectal temperature 28 degrees C) and group 2 (n = 897) in normothermia (rectal temperature 37 degrees C). Both groups had cold cardioplegic arrest (10 degrees C) and local cooling of the heart with slush. Anaesthesia and operative techniques were identical in both groups. The mean age was 60 years; group 2 contained significantly more patients aged > 65 years (P < 0.05) and had more frequent emergency operations (P < 0.001) than group 1. Other preoperative patient characteristics were similar between groups. Aortic cross-clamping time was similar in both groups but cardiopulmonary bypass time was significantly longer in group 1 than in group 2 (97.9(28.8) versus 76.6(26.0) min, P < 0.001). Perioperative mortality rate was 3.3% in group 1 and 2.6% in group 2. The incidence of myocardial infarction was significantly higher in group 1 than in group 2 (2.0% versus 0.7%) Perioperative low cardiac output needing inotropic support was similar in both groups, but group 1 patients required more intra-aortic balloon insertions (4.6% versus 2.2%, P < 0.05). Lower incidence of postoperative ventricular arrhythmias, shorter intubation time and less transient renal failures were significant in group 2 compared with those in group 1 (P < 0.001), while re-exploration of bleeding, wound infections, pulmonary, neurological and gastrointestinal complications did not differ. Blood transfusion was less in group 2 (1.2(1.1) units, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)