Hemodynamics and oxygen consumption during warm heart surgery

We compared the effects of normothermic cardiopulmonary bypass (CPB) with those of hypothermic CPB in patients who underwent coronary artery bypass grafting (CABG) with respect to hemodynamics and oxygen balance. The patients in our study were divided into two groups according to temperature during CPB: systemic normothermia combined with warm blood cardioplegia (group W,n=36) and systemic hypothermia combined with cold crystalloid cardioplegia (group C,n=26). In group W, the use of directcurrent (DC) defibrillators was less frequent after release of the cross clamp, and the duration of CPB and of reperfusion was shorter. After CPB, the cardiac index and arterial pressure were higher and the dosages of dopamine were lower in group W than in group C. The serum glucose level during and after CPB was lower and the base excess during CPB was higher in group W than in group C. Oxygen consumption (\(\dot Vo_2 \)) was unchanged throughout the operation in group W, while it decreased during CPB and increased at the end of surgery in group C. The oxygen extraction ratio (ERo2) increased during CPB in group W, while it was unchanged throughout the operation in group C. Mixed venous oxygen saturation (\(S\bar vo_2 \)) was maintained above 65% during and after CPB in group W and group C. Our results showed that normothermia may be superior to hypothermia during CPB with respect to recovery of cardiac function and avoidance of hyperglycemia. The whole-body oxygen demand-supply balance may be preserved during normothermic as well as hypothermic CPB.