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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 694-704, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DR Spahn, LR Smith, CD Veronee, RL McRae, WC Hu, AJ Menius, JE Lowe and BJ Leone
The use of isovolemic hemodilution to prevent adverse side effects of
homologous blood transfusions has increased. The lowest level of hemoglobin
that can be tolerated without regional myocardial dysfunction, however, had
not been precisely defined for left ventricular myocardium with compromised
coronary blood flow. This level was determined in our study in 19 dogs with
critical stenosis of the left anterior descending coronary artery during
graded isovolemic hemodilution. Regional function was assessed by
sonomicrometry in the territory supplied by the left anterior descending
coronary artery, as well as in two noncompromised left ventricular areas;
oxygen extraction and consumption in the left anterior descending coronary
artery region were assessed by analysis of anterior descending coronary
venous oxygen saturation. The median lowest level of hemoglobin tolerated
without contractile dysfunction of the territory supplied by the left
anterior descending artery was 7.5 gm/dl, with lower and upper quartiles of
6 and 9 gm/dl. In addition to a marked increase in cardiac output and
transstenotic left anterior descending flow, global cardiac and regional
myocardial functions were unchanged at a hemoglobin level of 7.5 gm/dl, as
compared with a control level of hemoglobin of 12.0 +/- 0.4 gm/dl. At a
mean level of hemoglobin of 6.0 +/- 0.4 gm/dl, marked contractile
dysfunction developed in the left anterior descending region: Systolic
shortening decreased from 24.2% +/- 2.1% to 17.9% +/- 1.9% (p < 0.01);
postsystolic shortening increased from 4.0% +/- 3.0% to 12.2% +/- 3.8% (p
< 0.01); and in the left anterior descending region, oxygen consumption
decreased. The increase of arterial level of hemoglobin by only 1.9 +/- 0.2
gm/dl restored contractile function in the left anterior descending region,
regional oxygen consumption, and oxygen extraction across the left anterior
descending region. Moderate isovolemic hemodilution is relatively well
tolerated in left ventricular myocardium with compromised coronary blood
flow, and hemodilution regional contractile dysfunction induced by
hemodilution is reversible by minimal blood transfusion.
ARTICLES
Acute isovolemic hemodilution and blood transfusion. Effects on regional function and metabolism in myocardium with compromised coronary blood flow
Department of Anesthesiology, Duke, Durham, N.C.
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