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J Thorac Cardiovasc Surg 1997;114:475-481
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

INFLUENCE OF NORMOTHERMIC SYSTEMIC PERFUSION DURING CORONARY ARTERY BYPASS OPERATIONS: A RANDOMIZED PROSPECTIVE STUDY

Supported by the Garfield Weston Trust and the British Heart Foundation.

Received for publication Nov. 25, 1996; revisions requested Feb. 13, 1997; revisions received March 31, 1997; accepted for publication April 1, 1997. Address for reprints: G. D. Angelini, FRCS, British Heart Foundation Professor of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom.

Abstract

Objectives: Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypothermic bypass for the maintenance of the body during cardiac surgery. The aims of this study were to investigate the effects of systemic perfusion temperature on clinical outcome after coronary revascularization. Methods: Three hundred patients (mean age 60 ± 9 years, 88% male) were prospectively randomized into three groups: hypothermia (28° C, n = 100), moderate hypothermia (32° C, n = 100), and normothermia (37° C, n = 100). All patients received cold antegrade St. Thomas' Hospital crystalloid cardioplegic solution, and patients in the normothermic group were actively rewarmed during cardiopulmonary bypass (nasopharyngeal temperature 37° C). Results: No differences were found between groups with respect to mortality (1%), intraaortic balloon pump use, perioperative infarctionrates, focal neurologic deficits (1%), intubation time, intensive care unit stay, and postoperative hospital stay. Further stepwise regression analysis identified age and intensive care unit stay as important predictors of the variability in postoperative stay (both R² = 0.114, p < 0.001), whereas perfusion temperature remained a nonsignificant explanator. Normothermic perfusion necessitated larger doses of phenylephrine to maintain arterial pressure above 50 mm Hg during cardiopulmonary bypass (p < 0.0001 vs 28° C, p < 0.01 vs 32° C) but less requirement for electrical defibrillation during reperfusion (p < 0.05 vs 32°C, p < 0.01 vs 28° C). Total chest drainage was not different between groups, but patients undergoing normothermic cardiopulmonary bypass required less transfusion of blood (p < 0.05 vs 28° C and 32° C) and platelets (p < 0.04 vs 32< C, p < 0.001 vs 28° C) in the postoperative period. Conclusions: Cardiopulmonary bypass temperature did not influence early clinical outcome after routine coronary artery bypass operations. Normothermic systemic perfusion was associated with an increased requirement for vasoconstrictors and reduced requirements for electrical defibrillation and transfusion of blood products.

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