J Thorac Cardiovasc Surg 2001;121:1179-1186
© 2001 The American Association for Thoracic Surgery
Cardiopulmonary Support and Physiology
From the Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, Saitama-ken, Japan.
Supported by the institutional research fund of Saitama Cardiovascular and Respiratory Center.
Received for publication May 10, 2000 Revisions requested Sept 5, 2000; revisions received Sept 18, 2000. Accepted for publication Dec 1, 2000. Address for reprints: Kazuhiro Hashimoto, MD, Saitama Cardiovascular and Respiratory Center, Department of Cardiovascular Surgery, 1696 Itai, Konan-machi, Osato-gun, Saitama-ken, 360-0105, Japan (E-mail: drs-hashimoto @mti.biglobe.ne.jp).
Objective: This study is the first comparative investigation of hepatic blood flow and oxygen metabolism during normothermic and hypothermic cardiopulmonary bypass.
Methods: Twenty-four patients undergoing coronary bypass operations were randomly divided into 2 groups according to their perfusion temperatures, either normothermia (36°C) or hypothermia (30°C). The clearance of indocyanine green was measured at 3 points. Arterial and hepatic venous ketone body ratios (an index of mitochondrial redox potential) and hepatic venous saturation were measured.
Results: Hepatic blood flow in both groups was identical before, during, and after cardiopulmonary bypass (normothermia, 499 ± 111, 479 ± 139, and 563 ± 182 mL/min, respectively; hypothermia, 476 ± 156, 491 ± 147, and 560 ± 202 mL/min, respectively). The hepatic venous saturation levels were significantly lower during cardiopulmonary bypass in the normothermic group (normothermia, 41% ± 13%; hypothermia, 61% ± 18%; P < .01), indicating a higher level of oxygen extraction use. The arterial ketone body ratio in the hypothermic group decreased severely after the onset of cardiopulmonary bypass (P < .01) and did not return to its subnormal value (>0.7) until the second postoperative day. However, the reduction in arterial ketone body ratio was less severe in the normothermic group. The difference in hepatic venous ketone body ratios was more obvious, and the hepatic venous ketone body ratios in the normothermic group were statistically superior to those of the hypothermic group throughout the course (P < .05-.01).
Conclusions: Normothermic cardiopulmonary bypass provides adequate liver perfusion and results in a better hepatic mitochondrial redox potential than hypothermic cardiopulmonary bypass. Because arterial ketone body ratios reflect hepatic energy potential, normothermia was considered to be physiologically more advantageous for hepatic function.
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