title: Single atriocaval cannulation is associated with increased incidence of hypercirculatory failure after cardiopulmonary bypass.
abstract: Cardiopulmonary bypass (CPB) can lead to hypercirculatory cardiac failure (HCF). Despite the activation of inflammatory mediators, the infusion of cardioplegic solution into the systemic circulation may result in decreased systemic vascular resistance and thus may cause HCF. The present prospective study was conducted to investigate in cardiac surgical patients the effects of single atrial versus bi-caval venous drainage and intraoperative hemofiltration on the incidence of HCF.
  
  
  RESULTS
  120 patients undergoing coronary artery bypass surgery (CABG) were randomized in 3 groups: A- single atrial cannulation; B- single atrial cannulation and intraoperative zero fluid balance hemofiltration; C- bi-caval cannulation. Myocardial protection was performed using cold crystalloid cardioplegia (Bretschneider's HTK) administrated into the aortic root and moderate hypothermia (32 degree C). Hemodynamics, fluid balance, vasoactive drugs, body temperature, and hemoglobin/hematocrit ratio were recorded during and up to 12 hours after surgery. We noted a significantly increased incidence of HCF in-group A (32%, n=13) and B (40%, n=16) when compared to group C (10%, n=4, p<0.05), with significantly increased requirements for vasoactive medication in patients developing HCF.
  
  
  CONCLUSIONS
  The present study results demonstrate that single atrial cannulation is associated with a significantly higher incidence of HCF. This is presumably caused by infusion of cardioplegic solution into the systemic circulation.
authors.affiliation: Klinik für Thorax-, Herz- und Gefässchirurgie, Georg-August-University Göttingen, Robert Koch Strasse 40, D-37075 Göttingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Busch
authors.forename: H
authors.initials: H
authors.lastname: Sirbu
authors.forename: S
authors.initials: S
authors.lastname: Kazmaier
authors.forename: I
authors.initials: I
authors.lastname: Aleksic
authors.forename: M
authors.initials: M
authors.lastname: Friedrich
authors.forename: H
authors.initials: H
authors.lastname: Dalichau
authors.forename: W
authors.initials: W
authors.lastname: Buhre
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002404:Catheterization / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D014684:Venae Cavae / Q000601:surgery