Topical Hypothermia: Ineffective and Deleterious as Adjunct to Cardioplegia for Myocardial Protection

Nikas, Dimitris J.; Ramadan, Fuad; Elefteriades, John A.

doi:10.1016/s0003-4975(97)01261-7

Cited by 35 publications

(21 citation statements)

References 15 publications

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“…69,70 The myocardial drawbacks of hypothermia are numerous. Myocardial edema, a common histologic finding following cardiac surgery, could be due to inactivation of enzyme systems of the sarcolemma and sarcoplasmic reticulum, namely sodium-potassium adenosine triphosphatase and calcium adenosine triphosphatase.…”

Section: Rationale For Warm Cardioplegiamentioning

confidence: 99%

Warm Pediatric Cardiac Surgery: European Experience

Durandy

2010

Asian Cardiovasc Thorac Ann

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Cold pediatric cardiac surgery has been a dogma for 50 years. However, the beneficial effects of cold perfusion are counterbalanced by the drawbacks of hypothermia. Thus, we propose a major paradigm shift from hypothermic surgery to warm perfusion and intermittent warm blood cardioplegia. This approach gives satisfactory results even with prolonged aortic crossclamp times. The major advantages are reduced time to extubation and shorter intensive care unit stay. Warm pediatric surgery is an anecdotal phenomenon no more; over 10,000 procedures have been carried out in Europe. All types of cardiopathy have been treated, including arterial switch, total pulmonary anomalous venous return, interruption of the aortic arch, and hypoplastic left heart syndrome. Once surgeons decide to shift from hypothermia to normothermia, they never decide to shift back to hypothermia. This fact is evidence of the satisfactory clinical outcome obtained with this technique. The technique and the composition of microplegia is identical in all European centers, the only variable factor being the interval between microplegia injections, which varies from 10 to 25 min. We hope that the increasing interest in pediatric warm surgery will hearten new candidates.

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Section: Rationale For Warm Cardioplegiamentioning

confidence: 99%

Warm Pediatric Cardiac Surgery: European Experience

Durandy

2010

Asian Cardiovasc Thorac Ann

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“…Nikas et al 4 reported that topical cooling had no effect on myocardial temperature; however, it increased postoperative complications such as diaphragmatic injury, arrhythmias and their consequences by hypothermic myocyte injury. They believed topical hypothermia to be detrimental in cardiac surgical modalities 4. After their study, topical cooling become controversial in many cardiac surgery centres.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore the damage may occur because of cold application. This type of injury primarily depends on nerve demyelisation and is usually reversible in one year 4. Phrenic nerve injury after cardiac surgery is reported at 2–17% 17…”

Section: Diaphragm Pathologymentioning

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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“…Estas disfunciones del hemidiafragma izquierdo parecen deberse a la utilizació n de hipotermia tó pica como mé todo de protecció n miocá rdica 18 . La paresia o pará lisis, junto al dolor de la pared torá cica, puede contribuir a que se produzcan atelectasias, generalmente del ló bulo inferior izquierdo, y DP 19 . La segunda razó n es por el propio trauma de la cirugía con hemorragia postoperatoria en el espacio pleural.…”

Section: Postoperatorio Inmediatounclassified