CONTROLLED LIMB REPERFUSION IN PATIENTS HAVING CARDIAC OPERATIONS

Hypothesis: Severe limb ischemia in patients having cardiac operations may occur after intraaortic balloon pump insertion, prolonged femoral vessel cannulation, percutaneous cardiopulmonary bypass, dissecting a neurysms, or emboli, Normal blood reperfusion can cause a postischemic syndrome that increases morbidity and mortality, This clinical study is based on an experimental infrastructure patterned after controlled cardiac reperfusion, (1) It tests the hypothesis that controlled limb reperfusion (i,e,, modifying the composition of the initial reperfusat e and the conditions of reperfusion) reduces the local and systemic co mplications seen after normal blood reperfusion, (2) It reports initia l clinical application of this strategy in three cardiac surgery cente rs, Methods: Controlled limb reperfusion was applied to 19 patients wi th signs of severe prolonged unilateral or bilateral ischemia (includi ng paralysis, anesthesia, and muscle contracture); six patients (32%) were in cardiogenic shock The mean ischemic duration was 26 +/- 6 hour s. The reperfusion method includes a 30-minute infusion into the dista l vessels of a normothermic reperfusate solution mixed with the patien t's arterial blood (obtained proximal to the obstruction) in a 6:1 blo od/reperfusate ratio, Data are mean +/- standard error of the mean. Re sults: Sixteen patients (84%) survived with salvaged and functional li mbs at the time of discharge, No renal, cardiac, pulmonary, cerebral, or hemodynamic complications developed in the survivors, The three dea ths occurred in patients undergoing controlled limb reperfusion while in profound postoperative cardiogenic shock; neither postischemic edem a nor contracture developed in any of them, Conclusions: These finding s show that controlled limb reperfusion can be applied readily with st andard equipment that is used for cardiac surgery and may salvage limb s while reducing postreperfusion morbidity and mortality.