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Comparison of hypothermic and normothermic cardiopulmonary bypass in patients undergoing coronary artery bypass graft surgery

Year 2025, Volume: 11 Issue: 2, 289 - 295
https://doi.org/10.18621/eurj.1582534

Abstract

Objectives: Coronary artery bypass graft (CABG) surgery operations accompanied by cardiopulmonary bypass (CPB) are the most prominent treatment options. One of the basic application principles of the CPB system is the protection of vital organs by reducing metabolic rate and oxygen consumption with hypothermia. In this study, we aimed to investigate the effects of normothermia and hypothermia applications on clinical outcomes in CABG operations performed with CPB.

Methods: This single-center study was planned retrospectively. Patients who underwent isolated CABG operation with CPB at Şanlıurfa Mehmet Akif İnan Training and Research Hospital between January 01, 2020, and January 01, 2022, were included. A total of 120 patients, 60 of whom underwent hypothermic and 60 normothermic cardiac bypass, were included in the study after applying the exclusion criteria.

Results: There was no difference between the groups in terms of age, gender, diabetes mellitus, hypertension, left ventricular ejection fraction, and body surface area characteristics (P>0.05). In the normothermia group, urea, creatinine, direct bilirubin, and lactate levels were significantly higher in the first postoperative day blood values (P=0.003, P=0.04, P=0.028, P=0.005, and P<0.001, respectively). Positive inotropic agent requirement and defibrillation requirement after cross-clamping were significantly higher in the hypothermia group (P=0.006 and P=0.045, respectively).

Conclusions: In CABB operations performed with CPB, normothermia and hypothermia applications may have beneficial effects on different clinical situations.

Ethical Statement

This study was approved with the protocol dated 31/10/2022 and numbered HRÜ/22.21.05 of the Harran University Clinical Research Ethics Committee.

References

  • 1. Ay D, Engin M, Sünbül SA, et al. Syndecan-1 as a marker to predict acute kidney injury after isolated coronary artery bypass graft operations. Rev Assoc Med Bras (1992). 2023;69(1):107-111. doi:10.1590/1806-9282.20220839.
  • 2. Haider A, Khwaja IA, Qureshi AB, et al. Effectiveness of mild to moderate hypothermic cardiopulmonary bypass on early clinical outcomes. J Cardiovasc Dev Dis. 2022;9(5):151. doi: 10.3390/jcdd9050151.
  • 3. Ho KM, Tan JA. Benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery: a systematic review. Cardiovasc Ther. 2011;29(4):260-279. doi: 10.1111/j.1755-5922.2009.00114.x.
  • 4. Passaroni AC, Silva MA, Yoshida WB. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-45. doi: 10.5935/1678-9741.20150021.
  • 5. Bronicki RA, Hall M. Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S272-278. doi: 10.1097/PCC.0000000000000759.
  • 6. Linassi F, Maran E, De Laurenzis A, et al. Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes. Br J Anaesth. 2022;128(1):11-25. doi: 10.1016/j.bja.2021.09.042.
  • 7. Rosenthal LM, Tong G, Wowro S, et al. A Prospective clinical trial measuring the effects of cardiopulmonary bypass under mild hypothermia on the ınflammatory response and regulation of cold-shock protein RNA-binding motif 3. Ther Hypothermia Temp Manag. 2020;10(1):60-70. doi: 10.1089/ther.2018.0038.
  • 8. Xiong Y, Sun Y, Ji B, Liu J, Wang G, Zheng Z. Systematic review and meta-analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery. Paediatr Anaesth. 2015;25(2):135-142. doi: 10.1111/pan.12560.
  • 9. Merkle F, Boettcher W, Schulz F, et al. Reduction of microemboli count in the priming fluid of cardiopulmonary bypass circuits. J Extra Corpor Technol. 2003;35(2):133-138.
  • 10. Lomivorotov VV, Shmirev VA, Efremov SM, et al. Hypothermic versus normothermic cardiopulmonary bypass in patients with valvular heart disease. J Cardiothorac Vasc Anesth. 2014;28(2):295-300. doi: 10.1053/j.jvca.2013.03.009.
  • 11. Cakir H, Gur O, Ege T, Kunduracilar H, Ketenciler S, Duran E. Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass. J Cardiovasc Surg. 2013;54(3):397-401.
  • 12. Kaplan M, Karaagac A, Can T, et al. Open heart surgery at patient's own temperature without active cooling. Heart Surg Forum. 2018;21(3):E132-E138. doi: 10.1532/hsf.1985.
  • 13. Ziyaeifard M, Ghavidel A, Moradi A, Fatahi M, Salehzadeh A, Heidarzadeh H. Comparison of the Effects of Hypothermia and Normothermia on Cognitive Functions After Coronary Artery Bypass Surgery. Multidiscip Cardiovasc Ann. 2021;12(2):e111442. doi:10.5812/mca.111442.
  • 14. Amer GF, Elawady MS, ElDerie A, Sanad M. Normothermia versus Hypothermia during Cardiopulmonary Bypass in Cases of Repair of Atrioventricular Septal Defect. Anesth Essays Res. 2020;14(1):112-118. doi: 10.4103/aer.AER_123_19.
  • 15. Bianco V, Kilic A, Aranda-Michel E, et al. Mild hypothermia versus normothermia in patients undergoing cardiac surgery. JTCVS Open. 2021;7:230-242. doi: 10.1016/j.xjon.2021.05.020.
  • 16. Boodhwani M, Rubens FD, Wozny D, Nathan HJ. Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann Thorac Surg. 2009;87(2):489-495. doi: 10.1016/j.athoracsur.2008.10.078.
  • 17. Yuksel V, Canbaz S, Ege T. Comparison between normothermic and mild hypothermic cardiopulmonary bypass in myocardial revascularization of patients with left ventricular dysfunction. Perfusion. 2013;28(5):419-423. doi: 10.1177/0267659113483798.
  • 18. Lenkin AI, Zaharov VI, Lenkin PI, Smetkin AA, Bjertnaes LJ, Kirov MY. Normothermic cardiopulmonary bypass increases cerebral tissue oxygenation during combined valve surgery: a single-centre, randomized trial. Interact Cardiovasc Thorac Surg. 2013;16(5):595-601. doi: 10.1093/icvts/ivt016.
  • 19. Kim DS, Lee SI, Lee SB, Hyun MC, Cho JY, Lee YO. Outcome of inflammatory response after normothermia during cardiopulmonary bypass surgery in infants with isolated ventricular septal defect. Korean J Pediatr. 2014;57(5):222-225. doi: 10.3345/kjp.2014.57.5.222.
  • 20. Liang M, Feng K, Yang X, et al. Moderate hypothermia provides better protection of the ıntestinal barrier than deep hypothermia during circulatory arrest in a piglet model: A microdialysis study. PLoS One. 2016;11(9):e0163684. doi: 10.1371/journal.pone.0163684.
Year 2025, Volume: 11 Issue: 2, 289 - 295
https://doi.org/10.18621/eurj.1582534

Abstract

References

  • 1. Ay D, Engin M, Sünbül SA, et al. Syndecan-1 as a marker to predict acute kidney injury after isolated coronary artery bypass graft operations. Rev Assoc Med Bras (1992). 2023;69(1):107-111. doi:10.1590/1806-9282.20220839.
  • 2. Haider A, Khwaja IA, Qureshi AB, et al. Effectiveness of mild to moderate hypothermic cardiopulmonary bypass on early clinical outcomes. J Cardiovasc Dev Dis. 2022;9(5):151. doi: 10.3390/jcdd9050151.
  • 3. Ho KM, Tan JA. Benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery: a systematic review. Cardiovasc Ther. 2011;29(4):260-279. doi: 10.1111/j.1755-5922.2009.00114.x.
  • 4. Passaroni AC, Silva MA, Yoshida WB. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine. Rev Bras Cir Cardiovasc. 2015;30(2):235-45. doi: 10.5935/1678-9741.20150021.
  • 5. Bronicki RA, Hall M. Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment. Pediatr Crit Care Med. 2016;17(8 Suppl 1):S272-278. doi: 10.1097/PCC.0000000000000759.
  • 6. Linassi F, Maran E, De Laurenzis A, et al. Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes. Br J Anaesth. 2022;128(1):11-25. doi: 10.1016/j.bja.2021.09.042.
  • 7. Rosenthal LM, Tong G, Wowro S, et al. A Prospective clinical trial measuring the effects of cardiopulmonary bypass under mild hypothermia on the ınflammatory response and regulation of cold-shock protein RNA-binding motif 3. Ther Hypothermia Temp Manag. 2020;10(1):60-70. doi: 10.1089/ther.2018.0038.
  • 8. Xiong Y, Sun Y, Ji B, Liu J, Wang G, Zheng Z. Systematic review and meta-analysis of benefits and risks between normothermia and hypothermia during cardiopulmonary bypass in pediatric cardiac surgery. Paediatr Anaesth. 2015;25(2):135-142. doi: 10.1111/pan.12560.
  • 9. Merkle F, Boettcher W, Schulz F, et al. Reduction of microemboli count in the priming fluid of cardiopulmonary bypass circuits. J Extra Corpor Technol. 2003;35(2):133-138.
  • 10. Lomivorotov VV, Shmirev VA, Efremov SM, et al. Hypothermic versus normothermic cardiopulmonary bypass in patients with valvular heart disease. J Cardiothorac Vasc Anesth. 2014;28(2):295-300. doi: 10.1053/j.jvca.2013.03.009.
  • 11. Cakir H, Gur O, Ege T, Kunduracilar H, Ketenciler S, Duran E. Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass. J Cardiovasc Surg. 2013;54(3):397-401.
  • 12. Kaplan M, Karaagac A, Can T, et al. Open heart surgery at patient's own temperature without active cooling. Heart Surg Forum. 2018;21(3):E132-E138. doi: 10.1532/hsf.1985.
  • 13. Ziyaeifard M, Ghavidel A, Moradi A, Fatahi M, Salehzadeh A, Heidarzadeh H. Comparison of the Effects of Hypothermia and Normothermia on Cognitive Functions After Coronary Artery Bypass Surgery. Multidiscip Cardiovasc Ann. 2021;12(2):e111442. doi:10.5812/mca.111442.
  • 14. Amer GF, Elawady MS, ElDerie A, Sanad M. Normothermia versus Hypothermia during Cardiopulmonary Bypass in Cases of Repair of Atrioventricular Septal Defect. Anesth Essays Res. 2020;14(1):112-118. doi: 10.4103/aer.AER_123_19.
  • 15. Bianco V, Kilic A, Aranda-Michel E, et al. Mild hypothermia versus normothermia in patients undergoing cardiac surgery. JTCVS Open. 2021;7:230-242. doi: 10.1016/j.xjon.2021.05.020.
  • 16. Boodhwani M, Rubens FD, Wozny D, Nathan HJ. Effects of mild hypothermia and rewarming on renal function after coronary artery bypass grafting. Ann Thorac Surg. 2009;87(2):489-495. doi: 10.1016/j.athoracsur.2008.10.078.
  • 17. Yuksel V, Canbaz S, Ege T. Comparison between normothermic and mild hypothermic cardiopulmonary bypass in myocardial revascularization of patients with left ventricular dysfunction. Perfusion. 2013;28(5):419-423. doi: 10.1177/0267659113483798.
  • 18. Lenkin AI, Zaharov VI, Lenkin PI, Smetkin AA, Bjertnaes LJ, Kirov MY. Normothermic cardiopulmonary bypass increases cerebral tissue oxygenation during combined valve surgery: a single-centre, randomized trial. Interact Cardiovasc Thorac Surg. 2013;16(5):595-601. doi: 10.1093/icvts/ivt016.
  • 19. Kim DS, Lee SI, Lee SB, Hyun MC, Cho JY, Lee YO. Outcome of inflammatory response after normothermia during cardiopulmonary bypass surgery in infants with isolated ventricular septal defect. Korean J Pediatr. 2014;57(5):222-225. doi: 10.3345/kjp.2014.57.5.222.
  • 20. Liang M, Feng K, Yang X, et al. Moderate hypothermia provides better protection of the ıntestinal barrier than deep hypothermia during circulatory arrest in a piglet model: A microdialysis study. PLoS One. 2016;11(9):e0163684. doi: 10.1371/journal.pone.0163684.
There are 20 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Original Articles
Authors

Bişar Amaç 0000-0003-0320-4239

Mesut Engin 0000-0003-2418-5823

Ahmet Kağan As 0000-0001-8098-4393

Mustafa Abanoz 0000-0003-1821-1706

Şenol Yavuz 0000-0001-5246-0808

Early Pub Date February 9, 2025
Publication Date
Submission Date November 10, 2024
Acceptance Date January 3, 2025
Published in Issue Year 2025 Volume: 11 Issue: 2

Cite

AMA Amaç B, Engin M, As AK, Abanoz M, Yavuz Ş. Comparison of hypothermic and normothermic cardiopulmonary bypass in patients undergoing coronary artery bypass graft surgery. Eur Res J. 11(2):289-295. doi:10.18621/eurj.1582534

e-ISSN: 2149-3189 


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