Key result
Normothermic cardiopulmonary bypass resulted in higher skeletal muscle tissue perfusion and interstitial metabolite concentrations compared to hypothermic bypass.
Why the study?
Does hypothermic cardiopulmonary bypass alter skeletal muscle metabolism and blood flow compared to normothermic cardiopulmonary bypass in patients undergoing surgical revascularization?
Cohort (n=50)
Does hypothermic cardiopulmonary bypass alter skeletal muscle metabolism and blood flow compared to normothermic cardiopulmonary bypass in patients undergoing surgical revascularization?
Normothermic cardiopulmonary bypass is associated with higher skeletal muscle tissue perfusion and altered metabolic dynamics compared to hypothermic bypass during cardiac surgery.
Does not support changing bypass temperature strategies; leaves open effects on clinical outcomes in CABG.
The aim of this study was to monitor the metabolism and blood flow in the interstitium of the skeletal muscle during cardiac surgery with cardiopulmonary bypass (CPB) and in the early postoperative period by means of microdialysis and to compare metabolic changes during CPB at normothermia (NT) and hypothermia (HT). Surgical revascularization using CPB was performed in 50 patients, 25 patients (group HT) were operated using hypothermic CPB, 25 (group NT) using normothermic CPB. Interstitial microdialysis was performed by two CMA 60 probes (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Constituents analysed in the obtained dialysates, collected at intervals, were glucose, urea, glycerol and lactate. Tissue blood flow was monitored by dynamic microdialysis with gentamicin as a marker. In both groups, NT versus HT, similar dynamics of concentrations were found. Low initial concentrations were followed by gradual increases during CPB and in the following phase of the operation. Concentrations were higher in the NT group. Immediately after the operation, the decrease in values continued, with a gradual increase in the succeeding postoperative period in both groups. Similar dynamic changes in the lactate concentration were found in both groups. The gentamicin concentrations were lower in the NT group (versus the HT group). The results showed dynamic changes in the interstitial concentrations of glucose, urea, glycerol and lactate, which depend on the phase of the surgery in the CPB and early postoperative phase in the both groups of patients. Higher tissue perfusion of the skeletal muscle was noted in those patients operated on in normothermia. The dynamics of the concentration changes of these substances in the interstitium of the skeletal muscle has been proven to be caused by both the metabolic activity of the tissue and by the blood flow through the interstitium of the muscle.
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Manďák et al. (2004) conducted a cohort in Cardiac surgery with cardiopulmonary bypass (n=50). Normothermic cardiopulmonary bypass vs. Hypothermic cardiopulmonary bypass was evaluated on Metabolism and blood flow in the interstitium of the skeletal muscle. Normothermic cardiopulmonary bypass resulted in higher skeletal muscle tissue perfusion and interstitial metabolite concentrations compared to hypothermic bypass.
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