[Superior results of ketone body ratio in pulsatile normothermic cardiopulmonary bypass; comparison with non-pulsatile cardiopulmonary bypass].
Sixteen patients undergoing aortocoronary bypass surgery under normothermic cardiopulmonary bypass were divided into 2 groups according to the either addition or none of pulsatility induced by intra-aortic balloon pumping (IABP). In those patients, hepatic blood flow was measured 3 times before, during and after cardiopulmonary bypass. Additionally, arterial and hepatic ketone body ratios [(AKBR) and (HKBR)], and hepatic venous saturation (ShvO2) were measured throughout and after the surgery.


RESULTS
The hepatic blood flows measured at 3 different times at the surgery were much more in the pulsatile group (p < 0.05). The values of AKBR, indicator of mitochondrial redox potential in hepatocytes, were maintained in nearly normal in the pulsatile group, but were suppressed in the non-pulsatile group. This trend was much more obvious in the values of HKBR. The significantly lower ShvO2 levels were observed in the non-pulsatile group during the cardiopulmonary bypass (p < 0.05).


CONCLUSIONS
Pulsatile normothermic cardiopulmonary bypass induced by IABP provides better liver perfusion and results in a better hepatic metabolism than non-pulsatile cardiopulmonary bypass.
Department of Medical Engineering, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
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Kamiyashiki
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Hashimoto
D000368:Aged; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000379:methods*; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007657:Ketone Bodies / Q000097:blood*; D008099:Liver / Q000378:metabolism*; D008102:Liver Circulation; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow
D007657:Ketone Bodies