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J Thorac Cardiovasc Surg 1995;110:340-348
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

A RANDOMIZED STUDY OF THE INFLUENCE OF PERFUSION TECHNIQUE AND pH MANAGEMENT STRATEGY IN 316 PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY:I. Mortality and cardiovascular morbidity

London and Ottawa, Ontario, and Vancouver, British Columbia, Canada

Supported by grant A1498 from the Heart and Stroke Foundation of Ontario.

Presented in part at the Sixty-seventh Congress of the International Anesthesia Research Society, San Diego, Calif., March 1993.

Received for publication Aug. 2, 1994. Accepted for publication Dec. 22, 1994. Address for reprints: John M. Murkin, MD, FRCPC, Department of Anaesthesia, University Hospital, 339 Windermere Rd., London, Ontario, Canada N6A 5A5.

Abstract

The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome. Methods: This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations. Results: Cardiovascular morbidity and mortality were not affected by pH management, and the incidence of stroke (2.5%) did not differ between groups. Overall in-hospital mortality was 2.8%, eight of the nine deaths occurring in the nonpulsatile group (5.1% versus 0.6%; p = 0.018). The incidence of myocardial infarction was 5.7% in the nonpulsatile group and 0.6% in the pulsatile group (p = 0.010), and use of intraaortic balloon pulsation was significantly more common in the nonpulsatile group (7.0% versus 1.9%; p = 0.029). The overall percentage of patients having major complications was also significantly higher in the nonpulsatile group (15.2% versus 5.7%; p = 0.006). Duration of cardiopulmonary bypass, age, and use of nonpulsatile perfusion all correlated significantly with adverse outcome. Conclusions: Use of pulsatile perfusion during cardiopulmonary bypass was associated with decreased incidences of myocardial infarction, death, and major complications. (J THORACCARDIOVASCSURG1995;110:340-8)

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