Autologous blood donation before myocardial revascularization: a Holter-electrocardiographic analysis.
The influence of preoperative autologous blood donation on myocardial ischemia and arrhythmias was evaluated in 24 patients scheduled for coronary artery bypass grafting (CABG). All had a Holter recorder placed 24 hours before predonation (day 1), the cassette was changed prior to donation, and the recording continued for 24 hours thereafter (day 2). Each patient served as his or her own control, and observations made on day 2 were compared with those of day 1. Ischemia was quantitated by calculating the duration (C.Dur.) and the area (C. Area) of ischemic ST segment depressions, and ventricular premature beats (VPB) were classified according to the Lown grading system. Twenty-one men and 3 women were monitored. On day 1, 9 patients had 20 ischemic events, 3 being symptomatic. Nine patients demonstrated ischemia on day 2, representing a total of 3 symptomatic and 26 silent events. When comparing the two monitoring periods, 7 patients had longer or more severe ST segment depression whereas 6 other patients presented with more severe VPBs on day 2. Three patients had less ischemia on day 2, one remained stable, and 13 had no ischemia throughout the study. Silent ischemia was significantly more prolonged (C.Dur.Sil 316 v 152 sec, P < 0.05) and more intense (C. Area Sil 8 v 3.8 mm.min, P < 0.05) on day 2. Moreover, on top of a normal circadian distribution of ischemic events in the morning and in the evening, 40% of events were related to the donation or to a trip to the hospital. No preoperative characteristic helped to detect patients at risk.(ABSTRACT TRUNCATED AT 250 WORDS)
Van Dyck
M J
MJ
Department of Anesthesiology, Cliniques St-Luc, Catholic University of Louvain, Brussels, Belgium.
Baele
P L
PL
Leclercq
P
P
Bertrand
M
M
Brohet
C
C
D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001804:Blood Transfusion, Autologous; D005117:Cardiac Complexes, Premature / Q000503:physiopathology; D001026:Coronary Artery Bypass; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D009204:Myocardial Revascularization; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted
D006454:Hemoglobins