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J Thorac Cardiovasc Surg 2005;129:1371-1378
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Thermo-wrap technology preserves normothermia better than routine thermal care in patients undergoing off-pump coronary artery bypass and is associated with lower immune response and lesser myocardial damage

^a Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^d Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^b Cleveland Clinic Foundation, Cleveland, Ohio
^c Centre Cardiologique du Nord, Saint Dennis, Paris, France

Received for publication April 13, 2004; revisions received August 11, 2004; accepted for publication August 27, 2004.

^_* Address for reprints: Avi A. Weinbroum, MD, Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 64239, Israel. (Email: draviw{at}tasmc.health.gov.il).

OBJECTIVE: Perioperative hypothermia might be detrimental to the patient undergoing off-pump coronary artery bypass surgery. We assessed the efficacy of the Allon thermoregulation system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) compared with that of routine thermal care in maintaining normothermia during and after off-pump coronary artery bypass surgery.

METHODS: Patients undergoing off-pump coronary artery bypass surgery were perioperatively and randomly warmed with the 2 techniques (n = 45 per group). Core temperature, hemodynamics, and troponin I, interleukin 6, interleukin 8, and interleukin 10 blood levels were assessed.

RESULTS: The mean temperature of the patients in the Allon thermoregulation system group (AT group) was significantly (P < .005) higher than that of the patients receiving routine thermal care (the RTC group); less than 40% of the latter reached 36°C compared with 100% of the former. The cardiac index was higher and the systemic vascular resistance was lower (P < .05) by 16% and 25%, respectively, in the individuals in the AT group compared with in the individuals in the RTC group during the 4 postoperative hours. End-of-surgery interleukin 6 levels and 24-hour postoperative troponin I levels were significantly (P < .01) lower in the patients in the AT group than in the RTC group. The RTC group’s troponin levels closely correlated with their interleukin 6 levels at the end of the operation (R = 0.51, P = .002).

CONCLUSIONS: Unlike routine thermal care, the Allon thermoregulation system maintains core normothermia in more than 80% of patients undergoing off-pump coronary artery bypass surgery. Normothermia is associated with better cardiac and vascular conditions, a lower cardiac injury rate, and a lower inflammatory response. The close correlation between the increased interleukin 6 and troponin I levels in the routine thermal care group indicates a potential deleterious effect of lowered temperature on the patient’s outcome.

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