Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Aortic Surgery without Infusion of Cardioplegic Solution at Total Circulatory Arrest

  • Lee, Hae Young (Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Kim, Dong Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2012.07.16
  • Accepted : 2012.11.20
  • Published : 2013.02.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Minimal infusion of cardioplegic solution (CPS) during aortic surgery using total circulatory arrest (TCA) may reduce several potential side effects: clamping on a diseased aorta, insult of coronary ostia, and edema. Materials and Methods: From 2006 to 2009, 72 patients underwent aortic surgery without infusion of cardioplegic solution at the initiation of circulatory arrest. The diagnoses were acute aortic dissection (44), aneurysm (22), and intramural hematoma (6). Results: The duration of TCA, the lowest nasopharyngeal temperature, bypass time, and aortic clamp time was 45 minutes, $16.4^{\circ}C$, 162 minutes, and 100 minutes, respectively. The amount of CPS was 1,050 mL, and 15 patients underwent surgery without CPS. The average inotrope score was 113 points (range, 6.25 to 5,048.5 points) corresponding to the dopamine infusion of 5 mcg/kg/min for 1 day. Seven patients showed a level of creatine kinase-MB above 50 ng/mL, postoperatively, compared with the average of 12.75 ng/mL. The ischemic change was found on electrocardiogram in 5 patients, postoperatively. There was no cardiac morbidity requiring mechanical assist. The average of intensive care unit stay and postoperative hospital stay was 40 hours (range, 15 to 482 hours) and 11 days, respectively. Conclusion: Minimal infusion of only retrograde CPS during rewarming without initial infusion at TCA in aortic surgery is feasible and can be used with acceptable results.

Keywords

References

  1. Kirklin JW, Barratt-Boyes BG. Cardiac surgery: hypothermia, circulatory arrest, and cardiopulmonary bypass. 3rd ed. New York: Churchill Livingstone; 2003.
  2. Bigelow WG, Lindsay WK, Greenwood WF. Hypothermia; its possible role in cardiac surgery: an investigation of factors governing survival in dogs at low body temperatures. Ann Surg 1950;132:849-66. https://doi.org/10.1097/00000658-195011000-00001
  3. Bigelow WG, Lindsay WK, Harrison RC, Gordon RA, Greenwood WF. Oxygen transport and utilization in dogs at low body temperatures. Am J Physiol 1950;160:125-37.
  4. Boerema I, Wildschut A, Schmidt WJ, Broekhuysen L. Experimental researches into hypothermia as an aid in the surgery of the heart. Arch Chir Neerl 1951;3:25-34.
  5. Guiot G, Rougerie J, Arfel G, Dubost C, Blondeau P. "Extreme cold" in neurosurgery: possibilities and future perspectives: reflections apropos of the 1st case of vascular malformation operated on with success under prolonged circulatory arrest and hypothermia at 10 degrees. Neurochirurgie 1960;6:332-46.
  6. Weiss M, Piwnica A, Lenfant C, et al. Deep hypothermia with total circulatory arrest. Trans Am Soc Artif Intern Organs 1960;6:227-39.
  7. Lillehei CW, Todd DB Jr, Levy MJ, Ellis RJ. Partial cardiopulmonary bypass, hypothermia, and total circulatory arrest: a lifesaving technique for ruptured mycotic aortic aneurysms, ruptured left ventricle, and other complicated cardiac pathology. J Thorac Cardiovasc Surg 1969;58:530-44.
  8. Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg 1975;70:1051-63.
  9. Conti VR, Bertranou EG, Blackstone EH, Kirklin JW, Digerness SB. Cold cardioplegia versus hypothermia for myocardial protection: randomized clinical study. J Thorac Cardiovasc Surg 1978;76:577-89.
  10. Fuhrman GJ, Fuhrman FA. Oxygen consumption of animals and tissues as a function of temperature. J Gen Physiol 1959;42:715-22. https://doi.org/10.1085/jgp.42.4.715
  11. Fuhrman FA. Oxygen consumption of mammalian tissue at reduced temperatures. In: Dripps RD, editor. The physiology of induced hypothermia. Washinton (DC): National Academy of Sciences, National Research Council; 1956. p. 50.
  12. Field 2nd J, Belding HS, Martin AW. An analysis of the relation between basal metabolism and summated tissue respiration in the rat: the post-pubertal albino rat. J Cell Comp Physiol 1939;14:143-57. https://doi.org/10.1002/jcp.1030140202
  13. Fuhrman FA, Fuhrman GJ, Farr DA, Fail JH. Relationship between tissue respiration and total metabolic rate in hypoand normothermic rats. Am J Physiol 1961;201:231-4.
  14. Busto R, Globus MY, Dietrich WD, Martinez E, Valdes I, Ginsberg MD. Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 1989;20:904-10. https://doi.org/10.1161/01.STR.20.7.904
  15. Widmann R, Miyazawa T, Hossmann KA. Protective effect of hypothermia on hippocampal injury after 30 minutes of forebrain ischemia in rats is mediated by postischemic recovery of protein synthesis. J Neurochem 1993;61:200-9. https://doi.org/10.1111/j.1471-4159.1993.tb03556.x
  16. Busto R, Globus MY, Neary JT, Ginsberg MD. Regional alterations of protein kinase C activity following transient cerebral ischemia: effects of intraischemic brain temperature modulation. J Neurochem 1994;63:1095-103.
  17. Nakashima K, Todd MM, Warner DS. The relation between cerebral metabolic rate and ischemic depolarization: a comparison of the effects of hypothermia, pentobarbital, and isoflurane. Anesthesiology 1995;82:1199-208. https://doi.org/10.1097/00000542-199505000-00015
  18. Rosenfeldt FL. The relationship between myocardial temperature and recovery after experimental cardioplegic arrest. J Thorac Cardiovasc Surg 1982;84:656-66.
  19. Swanson DK, Dufek JH, Kahn DR. Improved myocardial preservation at 4 degrees C. Ann Thorac Surg 1980;30: 518-26.
  20. English TA, Cooper DK, Medd R, Wheeldon D. Orthotopic heart transplantation after 16 hours of ischaemia. Proceedings of the British Cardiac Society. British Heart J 1980; 43:721-2.
  21. Norwood WI, Norwood CR, Castaneda AR. Cerebral anoxia: effect of deep hypothermia and pH. Surgery 1979;86:203-20.
  22. Zhang JX, Wolf MB. Effect of cold on ischemia: reperfusion- induced microvascular permeability increase in cat skeletal muscle. Cryobiology 1994;31:94-100. https://doi.org/10.1006/cryo.1994.1012
  23. Fremes SE, Weisel RD, Mickle DA, et al. Myocardial metabolism and ventricular function following cold potassium cardioplegia. J Thorac Cardiovasc Surg 1985;89:531-46.
  24. Weisel RD, Mickle DA, Finkle CD, Tumiati LC, Madonik MM, Ivanov J. Delayed myocardial metabolic recovery after blood cardioplegia. Ann Thorac Surg 1989;48:503-7. https://doi.org/10.1016/S0003-4975(10)66850-6
  25. Yau TM, Ikonomidis JS, Weisel RD, et al. Ventricular function after normothermic versus hypothermic cardioplegia. J Thorac Cardiovasc Surg 1993;105:833-43.
  26. Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: a comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995;92:2226-35. https://doi.org/10.1161/01.CIR.92.8.2226
  27. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11:234-8. https://doi.org/10.1097/PCC.0b013e3181b806fc