Clinical Physiology of Circulation
ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)
Chief Editor
Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery
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Heart and lungs protection techniques in anesthetic and perfusion management of heart valves surgery
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1 Nizhniy Novgorod State Medical Academy, Ministry of Health of the RF,
ploshchad’ Minina i Pozharskogo, 10/1, Nizhniy Novgorod, 603005, Russian Federation;
2 Special Clinical Cardiac Surgery Hospital, ul. Vaneeva, 209, Nizhniy Novgorod, 603950, Russian Federation
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Link: Clinical Physiology of Blood Circulaiton. 2014; (): -
Quote as: Pichugin V.V., Mel’nikov N.Yu., Sandalkin E.V., Medvedev A.P., Gamzaev A.B., Zhurko S.A., Chiginev V.A. Heart and lungs protection techniques in anesthetic and perfusion management of heart valves surgery. Klinicheskaya Fiziologiya Krovoobrashcheniya. 2014; 4: 50-59.
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Abstract
Objective of the study was to evaluate different heart and lungs protective techniques in heart valves surgery.Material and methods. After ethical approval and written informed consent 100 patients undergoing valves surgery with normothermic CPB were randomized in four groups. First group (control, 22 patients) – crystalloid cardioplegia (“Consol”) and no lung ventilation/perfusion technique were used, second group (30 patients) – constant coronary perfusion in con- dition of “beating heart” and no lung ventilation/perfusion technique were used, third group (20 patients) – crystalloid car- dioplegia (“Consol”) with lung ventilation/perfusion technique were used and fourth group (28 patients) – constant coronary perfusion in condition of “beating heart” with perfusion of pulmonary artery and lungs ventilation technique were used. Clinical (types of cardiac recovery after cardioplegia; postischemic cardiac rhythm disturbances; doses of inotropes), investigation of myocardial damage markers (CK MB level), oxygenation index and lung compliance were per- formed for comparative evaluation of effectiveness of these techniques.
Results. Clinical analysis of cardiac recovery and post bypass periods revealed prevalence of spontaneous cardiac rhythm recovery, and also decrease in requirement and dosages of inotropes at the end of surgery in patients of the 2nd and 4th groups was noted that indirectly testifies to the better myocardial preservation in these patients. Changes of postoperative levels of CK MB were characterized, firstly, by its lower release in blood directly after operation and, secondly, it’s faster normalization (in 24 h after operation) in patients of the 2nd and 4th groups. Changes in functional conditions of lungs were characterized by decrease in an index of oxygenation and lungs compliance after cardiopulmonary bypass with development of an arterial hypoxemia (in 10.0–13.6% of patients) in patients from 1st and 2nd groups. Lung ventilation during bypass with pulmonary artery perfusion effectively prevented decrease in oxygenation and lungs compliance, and also development of an arterial hypoxemia after cardiopulmonary bypass in patients of 3rd and 4th groups.
Conclusion. In summary it should be noted that comparative assessment of different techniques revealed its advantages in the “improved” myocardial protection (“beating heart” and “beating heart and breathing lungs” technique) and lungs protection (“breathing lungs” and “beating heart and breathing lungs” technique).
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