A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. I. Mortality and cardiovascular morbidity.
The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome.


METHODS
This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations.


RESULTS
Cardiovascular morbidity and mortality were not affected by pH management, and the incidence of stroke (2.5%) did not differ between groups. Overall in-hospital mortality was 2.8%, eight of the nine deaths occurring in the nonpulsatile group (5.1% versus 0.6%; p = 0.018). The incidence of myocardial infarction was 5.7% in the nonpulsatile group and 0.6% in the pulsatile group (p = 0.010), and use of intraaortic balloon pulsation was significantly more common in the nonpulsatile group (7.0% versus 1.9%; p = 0.029). The overall percentage of patients having major complications was also significantly higher in the nonpulsatile group (15.2% versus 5.7%; p = 0.006). Duration of cardiopulmonary bypass, age, and use of nonpulsatile perfusion all correlated significantly with adverse outcome.


CONCLUSIONS
Use of pulsatile perfusion during cardiopulmonary bypass was associated with decreased incidences of myocardial infarction, death, and major complications.
Murkin
J M
JM
Department of Anaesthesia, University Hospital, University of Western Ontario, London, Canada.
Martzke
J S
JS
Buchan
A M
AM
Bentley
C
C
Wong
C J
CJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011673:Pulsatile Flow; D051437:Renal Insufficiency / Q000209:etiology; D012307:Risk Factors
D002245:Carbon Dioxide