Hemodynamic and metabolic effects of venoarterial cardiopulmonary support in coronary artery disease.
Coronary angioplasty was performed on 14 high-risk patients supported with venoarterial partial cardiopulmonary bypass. Hemodynamic, metabolic and physiologic parameters were monitored to assess the effect of cardiopulmonary support in conscious patients. Cardiopulmonary support caused a decrease in systolic (45 +/- 17 to 27 +/- 14 mm Hg, p less than 0.001), diastolic (23 +/- 12 to 14 +/- 8 mm Hg, p less than 0.005) and mean (29.7 +/- 13.2 to 18 +/- 9 mm Hg, p less than 0.001) pulmonary artery pressures. Aortic systolic (129 +/- 18 to 106 +/- 17 mm Hg, p less than 0.001), mean (89 +/- 19 to 84 +/- 19 mm Hg, p less than 0.05) and pulse (64 +/- 17 to 37 +/- 16 mm Hg, p less than 0.00001) pressures also decreased. Heart rate and aortic diastolic pressures were unchanged. End-systolic wall stress (122 +/- 48 x 10(3) to 96 +/- 44 x 10(3) dynes/cm2, p less than 0.001) and left ventricular end-diastolic diameter (5.7 +/- 0.8 to 5.5 +/- 0.9 cm, p less than 0.05) were reduced during partial cardiopulmonary bypass. After initiation of cardiopulmonary support, normal lactate extraction across the coronary circulation was diminished or converted to lactate production (38 +/- 23 to 2 +/- 29%, p less than 0.005). There was a marked reduction in hematocrit (41 +/- 4 to 28 +/- 5%, p less than 0.0001) and platelet count (259,000 +/- 57,600/ml to 145,900 +/- 46,000/ml, p less than 0.0001) after bypass. Cardiopulmonary bypass successfully supported all patients during balloon inflation, for an optimal angioplasty result.(ABSTRACT TRUNCATED AT 250 WORDS)
Stack
R K
RK
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073-6769.
Pavlides
G S
GS
Miller
R
R
Bassett
J
J
Cieszkowski
J
J
Gangadharan
V
V
Sakwa
M
M
Clancy
P
P
O'Neill
W W
WW
D000368:Aged; D000693:Anaerobiosis / Q000502:physiology; D015906:Angioplasty, Balloon, Coronary; D002315:Cardiopulmonary Bypass; D003327:Coronary Disease / Q000503:physiopathology* / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007773:Lactates / Q000378:metabolism; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D007773:Lactates; D019344:Lactic Acid