Helvetica chirurgica acta
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Helvetica chirurgica acta · Dec 1993
Comparative Study[Is normothermic cardiopulmonary bypass associated with increased morbidity?].
There is some evidence of improved myocardial protection with warm continuous blood cardioplegia. Warm cardioplegia however implies warm (normothermic) cardiopulmonary bypass (CPB). We evaluated retrospectively the influence of bypass temperature on the intra- and postoperative course of 121 patients, operated on for valvular and/or coronary artery disease. Only elective procedures with continuous blood cardioplegia were included. The patients were divided in two groups: warm group (n = 78): normothermic CPB (venous temperature > 33 degrees C) cold group (n = 43): hypothermic CPB (< 33 degrees C). ⋯ there is no evidence of increased morbidity due to normothermic CPB. The shorter time until extubation may be due to a improved postoperative lung function and/or a more stable hemodynamic postoperative course after normothermic CPB.
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Helvetica chirurgica acta · Dec 1993
[Hemodilution tolerance in coronary heart disease: single vessel versus multiple vessel disease].
Isovolemic hemodilution is well tolerated in experimental models of single vessel coronary artery disease. Little information, however, is available on the hemodilution tolerance in presence of multivessel coronary artery disease. 42 dogs were anesthetized and instrumented to determine global cardiovascular and regional myocardial functions (systolic shortening, SS) in the anterior apical LV territory supplied by the left anterior descending coronary artery (LAD) as well as in the posterior apical LV wall supplied by the circumflex coronary artery (LC) using sonomicrometry. Critical coronary stenoses were imposed on the proximal LAD and LC according to the experimental group assignment and group 1V-HD (LC stenosis only) and group 2V-HD (LC and LAD stenoses) were then progressively hemodiluted using Dextran 70,000. 1000 ml blood per hour was thereby continuously exchanged with 900 ml Dextran until the animal expired or 120 minutes were reached. 12 dogs (LAD and LC stenoses) served as controls (2V-C). ⋯ Myocardial contractile function in the LC territory failed similarly in the 1V-HD and 2V-HD groups during progressive hemodilution. The LAD myocardium, however, responded markedly different in the 2V-HD as compared to the 1V-HD group: In the 2V-HD group, SSLAD started to decrease shortly into hemodilution, whereas SSLAD progressively increased during the first 60 min of continuous hemodilution in the 1V-HD group. The presence of non-compromised LV myocardium with the ability of a compensatory increase in contractile function thus seems to crucial for the hemodilution tolerance in the setting of coronary artery disease.