Cardiopulmonary bypass support for treatment of left ventricular failure following coronary artery bypass grafting: the effects on epicardial microflow and graft flow

Abstract

The relationship between graft blood flow, epicardial microflow and mean arterial pressure were studied to evaluate the use of repeated cardiopulmonary bypass (CPB) support for intraoperative heart failure following aorto-coronary bypass surgery.

Ten patients with unstable angina and suffering from intraoperative heart failure (group A) were compared to 22 patients with stable angina (group B). In group A, during heart failure, the mean arterial pressure fell by 41 % (29.9 ± 6.8 mmHg, p < 0.01), graft flow (GF) by 67% (9.2 ± 2.6 ml/min, p < 0.01) and epicardial microflow by 64% (19 ± 4 AU, p < 0.01). After 15-56 min of assisted CPB support, the epicardial microflow and GF were partially restored. There were significant correlations between GF, epicardial microflow and CPB time. In group B, after protamine infusion, the epicardial microflow and GF were significantly greater than group A values (66 ± 14 AU, p < 0.001 and 29 ± 9 ml/min, p < 0.001, respectively).

It is concluded that the use of temporary assisted CPB support to treat intraoperative heart failure allows the recovery of the myocardium and thereby restores the mean arterial pressure. The recovery of GF and epicardial flow occurred to a lesser extent. CPB support appeared to be suitable for about 60 min, probably because of increasing disturbance to the GF and the epicardial microcirculation.

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References

Royster RL Myocardial dysfunction following cardiopulmonary bypass: recovery patterns, predictors of inotropic need, theoretical concepts of inotropic administration . J Cardiothorac Vasc Anesth 1993; 7(suppl 2): 19-25.

Park SB , Liebler GA , Burkholder JA et al. Mechanical support of the failing heart. Ann Thorac Surg 1986; 42: 627-31.

Ballantyne CM , Verani MS , Short D. , Hyatt C. , Noon GP Delayed recovery of severely 'stunned' myocardium with support of a left ventricular assist device after coronary artery bypass surgery. J Am Coll Cardiol 1987; 10: 710-12.

Loop FD , Thomas JD Hypoperfusion after arterial bypass grafting. Ann Thorac Surg 1993; 56: 812-13.

Harris LJ , Crooke GA , LaMendola CL , Grossi EA , Baumann FG , Esposito RA Effects of graded reductions in internal mammary artery bypass flow on left ventricular function. Ann Thorac Surg 1993 ; 56: 1348-50.

Nilsson GE , Tenland, T. , Oberg PA Evaluation of laser Doppler flowmeter for measurement of tissue blood flow . IEEE Trans Biomed Engng 1982; 27: 597-604.

Al-Khaja N. , Belboul A. , Bergman B. , Roberts D. , William-Olsson G. Influence of pathologic blood cell microrheology on myocardial microcirculation in cardiac surgery using cardiopulmonary bypass. Vasc Surg 1990; 24: 73-80.

Al-Khaja N. , Bergman B. , Belboul A. , Roberts D. , Williams-Olsson G.

Cutaneous microcirculation and blood rheology following cardiopulmonary bypass: laser Doppler flowmetric and blood cell rheologic studies. Scand J Thor

Cardiovasc Surg 1988; 22: 149-53.

Louagie Yves AG, Haxhe JP, Buche M, Schoevaerdts JC. Intraoperative electromagnetic flowmeter measurements in coronary artery bypass grafts. Ann Thorac Surg 1994; 57: 357-364.

10.

Haycock KA, Roth J, Gagnon J, Finzer WF, Soper C, eds. StatView. The ultimate integrated data analysis and presentation system. Berkeley, CA: Abacus Concepts , 1992.

11.

Bailey Ntj. Statistical methods in biology, 7th edn. London: English University Press, 1973.

12.

Hill AB , Hill ID Bradford Hill's principle of medical statistics, 12th edn. London: Edward Arnold, 1991.

13.

He GW , Acuff TE , Yang CQ et al. Middle and proximal sections of the human internal mammary artery are not 'passive conduits'. J Thorac Cardiovasc Surg 1994; 108: 741-46.

14.

Kennedy JW , Kaiser GC , Fisher LD et al. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg 1980; 80: 876-87.

15.

Pierce WS , Parr Gvs , Myers JL et al. Ventricular assist pumping in patients with cardiogenic shock after cardiac operations. N Engl J Med 1981 ; 305: 1606-9.

16.

Belboul A. , Chen Y. , Al-Khaja N. et al. Intraoperative assessment of the epicardial microflow and graft flow after coronary bypass grafting. Eur J Cardiothorac Surg (submitted).

17.

Bergman P. , Al-Khaja N. , Belboul A. , Roberts D. Reduced white blood cell microrheology and postoperative complications associated with cardiopulmonary bypass. Vasc Surg 1990 ; 24: 223-28.

18.

Bergman P. , Friberg G. , Liu B. et al. Blood cell rheologic deterioration by complement activation during experimental prolonged perfusion with membrane oxygenator. Perfusion 1992; 7: 13-19.

19.

Horrow JC Protamine: A review of its toxicity. Anesth Analg 1985; 64: 348-61.

20.

Asou T. , Oe M. , Tominaga R. et al. Optimal timing for application of ventricular assist devices in patients who cannot be weaned from cardiopulmonary bypass. An experimental study. ASAIO Trans 1988; 34: 466-69.

21.

Sweeney MS , Frazier OH Device-support myocardial revascularization: safe help for sick hearts . Ann Thorac Surg 1992; 54: 1065-70.

22.

Krukenkamp IB Cold and warm blood cardioplegia. Scand J Thorac Cardiovasc Surg 1993: 41(suppl); 45-53.