Successful Application of Hypothermia Combined with Intra-Aortic Balloon Pump Support to Low-Cardiac-Output State After Open Heart Surgery

• Published in: Angiology 1996-06, Vol.47 (6), p.595-599
• Main Authors: Moriyama, Yukinori, Iguro, Yoshihumi, Shimokawa, Shinji, Saigenji, Hideaki, Toyohira, Hitosi, Taira, Akira
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Output, Low - etiology; Cardiac Output, Low - therapy; Coronary Artery Bypass; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart Valve Prosthesis; Hemodynamics - physiology; Humans; Hypothermia, Induced; Intensive care medicine; Intra-Aortic Balloon Pumping; Male; Medical sciences; Middle Aged; Oxygen Consumption - physiology; Postoperative Complications - therapy; Time Factors; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - therapy
• ISSN: 0003-3197; 1940-1574
• DOI: 10.1177/000331979604700608

The authors report a successful application of hypothermia, along with intra-aortic balloon pump (IABP) support, to postcardiotomy ventricular failure. Surface-cooling hypothermia was applied in 8 patients after open heart surgery. The original cardiac procedure consisted of 3 aortocoronary bypass graftings (ACBGs), 2 aortic valve replace ments (AVRs), 1 repair for left ventricular (LV) rupture after mitral valve replacement (MVR), 1 MVR+ACBG, and 1 MVR+AVR+tricuspid valve annuloplasty (TAP). Their ages ranged from fifty-two to sixty-eight years with a mean of sixty-one years. Hemodynamic criteria for induction of hypothermia included cardiac index (CI) less than 2.0 L/min/m2 with left atrial pressure greater than 18 mmHg despite the use of IABP and maximum pharmacologic support. Blood temperature was maintained at around 33°C. By six hours after induction of hypothermia the tissue oxygen consumption decreased significantly with no hemodynamic deterioration as compared with that before cooling. The duration of hypothermia ranged from thirty-six to one hundred fifty-nine hours with a mean of seventy-eight hours. All 8 patients finally discontinued IABP support with a mean driving time of one hundred thirty-two hours. Five of them were ultimately discharged from the hospital and returned to their previous life-style. The authors believe that, from the perspective of monetary and personal resources, the use of hypothermia with IABP support could be a therapeutic option for patients with postcardiotomy ventricular failure.