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Body perfusion during adult cardiopulmonary bypass is improved by pulsatile flow with intra-aortic balloon pump.
Onorati, F; Santarpino, G; Rubino, A S; Caroleo, S; Dardano, A; Scalas, C; Gulletta, E; Santangelo, E; Renzulli, A.
Afiliación
  • Onorati F; Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro, Italy. cchumg@hotmail.it
Int J Artif Organs ; 32(1): 50-61, 2009 Jan.
Article en En | MEDLINE | ID: mdl-19241364
ABSTRACT

PURPOSE:

To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion.

METHODS:

158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic balloon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure).

RESULTS:

IABP induced Surplus Hemodynamic Energy was 15.8-/+4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1-2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01).

CONCLUSION:

Pulsatile flow by IABP improves whole-body perfusion during CPB.
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Puente Cardiopulmonar / Puente de Arteria Coronaria / Síndrome de Respuesta Inflamatoria Sistémica / Hemodinámica / Contrapulsador Intraaórtico / Isquemia Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Int J Artif Organs Año: 2009 Tipo del documento: Article País de afiliación: Italia
Buscar en Google
Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Puente Cardiopulmonar / Puente de Arteria Coronaria / Síndrome de Respuesta Inflamatoria Sistémica / Hemodinámica / Contrapulsador Intraaórtico / Isquemia Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male Idioma: En Revista: Int J Artif Organs Año: 2009 Tipo del documento: Article País de afiliación: Italia