Clinical evaluation of normothermic cardiopulmonary bypass and cold cardioplegia.
BACKGROUND
To evaluate the validity of normothermic cardiopulmonary bypass (CPB) associated with topical hypothermia and cold cardioplegia technique.


METHODS
In a clinical prospective trial, a consecutive series of 100 patients, homogeneous for demographics, clinical and operative data, undergoing coronary artery bypass surgery were randomized for hypothermic CPB (rectal temperature 28-32 degrees C group A, 50 patients) and normothermic CPB (rectal temperature 35-37 degrees C, group B, 50 patients). In both groups of patients cold crystalloid cardioplegic solution and topical hypothermia was used.


RESULTS
During CPB group B patients had lower systemic vascular resistance (p=0.0001); they needed a significant (p=0.0001) increase in vasocostrictive. At the removal of aortic cross-clamp, a spontaneous sinus rhythm resumed in 48% of patients in group A and in 95% of group B patients (p=0.001). To disconnect CPB, vasoconstrictive drugs were used in 10% of patients in group B and in none of patients in group A (p=0.0001); vasodilating drugs were infused in 96% of patients in group A and in 40% of patients in group B (p=0.0001). In the immediate postoperative period, positive inotropic agents were used in 67% of patients in group A and in 22% of patients in group B (p= 0.0003); group B patients showed a more physiological rewarming, reduced periods of mechanical ventilation and an easier regulation of the volemia.


CONCLUSIONS
In our clinical experience the technique of cold heart and warm body proved to be safe and effective in simplifying surgical procedures and facilitating postoperative management.
Nappi
G
G
Department of Cardiac Surgery, Second University of Naples Medical School, V. Monaldi Hospital, Naples, Italy. Gianantonio.Nappi@unina2.it
Torella
M
M
Romano
G
G
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass; D003080:Cold Temperature; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014655:Vascular Resistance / Q000502:physiology