Superior extension of intraoperative brain damage in case of normothermic systemic perfusion during coronary artery bypass operations.
OBJECTIVE
Despite the controversies on the potential detrimental effects of normothermic cardiopulmonary bypass on neurologic outcome, to date no correlation between the severity of intraoperative brain lesions and the cardiopulmonary bypass temperature used at operation has been reported. This study compares the prevalence and the severity of brain lesions in patients who underwent operation in condition of normothermic versus hypothermic systemic perfusion.


METHODS
Data are derived from the analysis of 2987 consecutive primary isolated myocardial revascularizations performed at our institution between April 1990 and January 1997. Of these cases, 1385 procedures were hypothermic and 1602 procedures were normothermic systemic perfusion. In all cases the neurologic outcome and extent of ischemic areas were prospectively recorded.


RESULTS
Overall, 31 patients had a perioperative stroke (1.0%). The prevalence of neurologic events was similar in the 2 groups (15 cases in the hypothermic group and 16 cases in the normothermic perfusion group; P, not significant). However, the mean Glasgow Outcome Scale score and computed tomography-demonstrated extent of brain lesions were significantly worse in the normothermic group.


CONCLUSIONS
Although the prevalence of intraoperative stroke was similar with hypothermic or normothermic cardiopulmonary bypass, the use of normothermic systemic perfusion was associated with more extended brain damage at computed tomographic scan and with a worse neurologic outcome. These results demand caution in the use of normothermic cardiopulmonary bypass and claim further investigation on the neurologic safety of normothermia.
Gaudino
M
M
Department of Cardiac Surgery, Catholic University, Rome, Italy.
Martinelli
L
L
Di Lella
G
G
Glieca
F
F
Marano
P
P
Schiavello
R
R
Possati
G
G
D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002533:Cerebral Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D011183:Postoperative Complications; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013696:Temperature; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome