RESUMO
A simplified system was developed for administration of blood cardioplegia with reperfusion modification. This system utilizes a single pass stainless steel coil to eliminate the need for a separate heat exchanger circuit. This system was compared with an oxygenated crystalloid cardioplegia system which was utilized in a manner which allowed warm blood perfusion of the heart for the last three minutes of the crossclamp interval. Both of these systems were compared with regard to mortality, spontaneous defibrillation, myocardial temperature, blood usage and peak CK-MB levels. In this series of patients, no significant advantage of either system could be identified.
Assuntos
Sangue , Soluções Cardioplégicas , Reperfusão Miocárdica , Procedimentos Cirúrgicos Cardíacos , Soluções Cardioplégicas/administração & dosagem , Ponte Cardiopulmonar , Creatina Quinase/análise , Feminino , Parada Cardíaca Induzida/métodos , Humanos , Isoenzimas , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/instrumentação , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/prevenção & controleRESUMO
A major goal of new perfusion equipment is minimal trauma to blood elements. This study compares two perfusion systems, quantifies the change in blood components and generation of microemboli, as well as compares the hospital courses of each perfusion system. Forty-four coronary patients were assigned to either Group S, a silicone rubber membrane (SciMed) and centrifugal pump (Bio-Medicus) (N=19) or Group C (our routine equipment), a microporous polypropylene membrane (COBE CML) and roller pump (COBE) (N=25). The rise in plasma hemoglobin (26+/-14mg* in Group S and 26+/-17mg* in Group C), the drop in hematocrit (-15.0+/-3.9* in Group S and -14.7+/-3.8* in Group C at the second post-op day), and the decrease in platelet count (-152,000+/-78,000* in Group S and -129,000+/-52,000* in Group C) were similar in both groups. There was no difference in rise in post-op alveolar-arterial oxygen gradients or debris generated by each system. 27.7% in Group S required red cell transfusions and only 8% required red cell transfusions in Group C. There was no significant difference in clinical endpoints such as ICU stay, hospital stay and complication rate. We found no advantage to more expensive perfusion devices and no improvement upon the extensive CPB damage to formed blood elements. * p less than .001
