Topical Cooling for Myocardial Protection: The Results of a Prospective Randomized Study of the "Shallow Technique"

Cassese, Mauro; Martinelli, Gianluca; Nasso, Giuseppe; Anselmi, Amédéo; Filippo, Carlo Maria De; Braccio, Maurizio; Baraldi, Christian; Rosis, Maria Grazia De; Agnino, Alfonso

doi:10.1111/j.1540-8191.2006.00245.x

Cited by 15 publications

(5 citation statements)

References 16 publications

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“…Similarly, Cassese et al found that phrenic nerve injury and failure of extubation occurred more frequently with the use of iced slush (P = 0.009 and P = 0.034, respectively). 12 Additionally, Maccherini et al in their study titled "Warm heart surgery eliminates diaphragmatic paralysis", found that topical hypothermia causes transitory diaphragmatic paralysis, pleural effusions, and thoracentesis. 13 The opponents of Topical cooling with iceslush suggested that such maneuver does not provide additional cardioprotective effects, and is an unnecessary adjunct to myocardial protection in patients undergoing cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Does Ice Slush Placed Inside Pericardial Well During Mitral Valve Replacement Cause Injury to Phrenic Nerve

Abbas¹

2020

lmrj

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Objective of the study was to determine frequency of phrenic nerve injury during mitral valve replacement, with application of Ice Slush, and compare it with international data. This study was performed at Punjab Institute of Cardiology Pakistan from January 2010 to December 2015. A total of 1105 patients with only primary rheumatic mitral valve disease were prospectively observed. A total of 931 patients were enrolled into the study. After sternotomy & cardiopulmonary bypass (CPB) at 28-32°C, antegrade blood cardioplegia with potassium, Ice slush was applied all the time during repair or replacement of the mitral valve. A pre-designed proforma was used, that recorded phrenic nerve injury. Statistical Package for Social Sciences (SPSS) for Windows version 21 was used for the analysis of data. Out of 931 patients who underwent mitral valve repair or replacement, 466 (50.1%) were males. Time spent on CPB ranged from 40 to 120 min; in 58.1% patients the time remained less than 80 minutes. As far as the ascending aortic cross clamp time was concerned, 83.1% patients had less than 40 minutes of cross clamp time. Post-operative chest X-ray remained normal in 97.5% patients whereas it showed atelectasis in 2.3% and elevated left hemidiaphragm in 0.2% of the patients. The total in-hospital mortality was 3.2% during study period. No patient was found to have phrenic nerve injury, unilateral or bilateral, during the study period.Topical cooling of heart, during mitral valve replacement, with Ice slush per se is not responsible for Phrenic nerve injury.

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Section: Discussionmentioning

confidence: 99%

Does Ice Slush Placed Inside Pericardial Well During Mitral Valve Replacement Cause Injury to Phrenic Nerve

Abbas¹

2020

lmrj

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“…Necessity for drainage and amounts of pleural effusions, diaphragm paralysis and elevations were recorded. Diaphragm changes above two or more ribs were determined as a positive result, according to the current literature data 3. Positive echocardiographic changes were determined as follows: new development of valve disorders, structural or transactional changes of the ventricular wall, aneurysm formation and a decrease in EF of more than 10%.…”

Section: Methodsmentioning

confidence: 99%

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

Kadan¹,

Erol²,

Oz³

et al. 2014

CVJA

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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.

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“…Die myokardiale Hypothermie hat heute also nur einen geringen Anteil an der Protektion; in klinischen Untersuchungen hat auch eine topische Kühlung keine zusätzlichen Vorteile gezeigt [4]. Sie kann als Komplikation aber zu kältebedingten Phrenikusschä-den führen [8]. Nur bei langen Ischämie-zeiten oder besonderen Risikopatienten könnte eine zusätzliche Kühlung mit einer kalten gegenüber einer warmen Kardioplegie Vorteile bringen [22,26].…”

Section: Hypothermie Und Myokardprotektionunclassified

“…Reduzierung der operativ notwendigen Ischämie entwickelt und mit sehr guten Ergebnissen eingesetzt. Neben einer guten Metaanalyse zur Kardioplegie von Guru et al [11] kann hier aus der Vielzahl der Arbeiten zu diesem Thema nur auf einige aktuelle hingewiesen werden [8,22,26]. Zusammenfassend ist festzustellen, dass eine zusätzliche topische Küh-lung und die Verwendung kalter, kristalloider Kardioplegielösungen zunehmend verlassen werden, da eine systemische Normothermie und eine Myokardprotektion mit einer Blutkardioplegie günstige-re Ergebnisse zeigen und dabei die Nachteile einer Hypothermie vermieden werden.…”

Section: Hypothermie Und Myokardprotektionunclassified

Hypothermia in cardiac surgery

Schirmer

2007

Anaesthesist

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Since the beginning of the era of cardiac surgery hypothermia remains a mainstay in perioperative management. This role is increasingly being questioned because of many disadvantages and the lack of evidence of advantages. Using modern techniques of perfusion and myocardial protection as well as improved surgical techniques the results with normothermia seem to be comparable. The importance of hypothermia in present day cardiac surgery is discussed with respect to myocardial and cerebral protection.

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Topical Cooling for Myocardial Protection: The Results of a Prospective Randomized Study of the "Shallow Technique"

Abstract: ST likely reduces the incidence of postoperative PNI and might be protective mainly in the event of ITA harvest. It should be considered as a valuable tool for myocardial protection protocols.

Cited by 15 publications

References 16 publications

Does Ice Slush Placed Inside Pericardial Well During Mitral Valve Replacement Cause Injury to Phrenic Nerve

Does Ice Slush Placed Inside Pericardial Well During Mitral Valve Replacement Cause Injury to Phrenic Nerve

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

Hypothermia in cardiac surgery

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