Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery : cardiovascular topic

Abstract

SummaryBackgroundWe aimed to examine the effects of topical hypothermia on inflammatory markers in patients undergoing coronary artery bypass surgery.MethodsFifty patients undergoing isolated coronary artery bypass surgery were included the study. They were randomised to two groups. Mild hypothermic cardiopulmonary bypass (28–32°C) was performed on both groups using standardised anaesthesiology and surgical techniques. Furthermore, topical cooling with 4°C saline was performed on patients in group I. We recorded peri-operative and intra-operative results of blood samples, pre-operative and postoperative outcomes of electrocardiography and echocardiography, diaphragm levels on X-ray, and the necessity of positive inotropic medication and intra-aortic balloon pump (IABP).ResultsTime-dependent changes in blood samples were compared between the two groups. The changes on complement 3 (C3) and TNF-α levels were more significant in group I than group II (p < 0.05 and p < 0.001, respectively). Spontaneous restoration rate of sinus rhythm was higher in group II than group I (80 vs 32%, p < 0.01). Atrial fibrillation was seen in six patients in group I and one patient in group II (p < 0.05). IABP was performed on four patients (16%) in group I (p < 0.05). Diaphragmatic paralysis was seen in seven patients in group I but not in group II (p < 0.01). Partial pericardiotomy rates were compared within the groups but there was no statistically significant difference (p > 0.05). One patient in group I died on the 18th postoperative day, but operative mortality rate was not statistically significant between the two groups (p > 0.05).ConclusionsTopical hypothermia had a negative impact on inflammatory markers and postoperative morbidities.

Myocardial protection using single dose del Nido Cardioplegia with and without topical cooling

“…We did not measure myocardial temperature in early reperfusion but can speculate that faster spontaneous rhythm recovery in DN-H could be related to almost normothermic myocardium at the end of ischemia in that group. Furthermore, epicardial cooling has been shown to induce temporary electrocardiographic disturbances 26 and increase inflammatory response, 27 which in turn may lead to the need of more defibrillations. 28 The use of topical cooling derives its benefit from decreased myocardial energy consumption during arrest, yet there is growing evidence that it may not provide additional benefit regardless of the type of cardioplegia used (blood vs. crystalloid).…”

Evaluation of Risk Factors for Atrial Fibrillation Occurring After Coronary Bypass Surgery

“…Kardiyoplejik arrest sırasında atriyal ısı, ventriküllerle karşılaş-tırıldığında genellikle daha yüksektir. Yetersiz atriyal ve atrioventriküler nodal hipotermi, ileti sisteminin iskemik hasarına yol açarak arrest sonrası ileti bozukluklarına neden olabilir (12,13) . Özellikle anormal elektrofi zyolojik yapıya sahip olanlarda kros klemp süresinin uzamasına bağlı olarak atriyal iskeminin artışı, postop AF gelişimine neden olabilir.…”