SUCCESSFUL APPLICATION OF HYPOTHERMIA COMBINED WITH INTRAAORTIC BALLOON PUMP SUPPORT TO LOW-CARDIAC-OUTPUT STATE AFTER OPEN-HEART-SURGERY

The authors report a successful application of hypothermia, along with intra-aortic balloon pump (IABP) support, to postcardiotomy ventricul ar failure. Surface-cooling hypothermia was applied in 8 patients afte r open heart surgery. The original cardiac procedure consisted of 3 ao rtocoronary bypass graftings (ACBGs), 2 aortic valve replacements (AVR s), 1 repair for left ventricular (LV) rupture after mitral valve repl acement (MVR), 1 MVR+ACBG, and 1 MVR+AVR+tricuspid valve annuloplasty (TAP). Their ages ranged from fifty-two to sixty-eight years with a me an of sixty-one years. Hemodynamic criteria for induction of hypotherm ia included cardiac index (CI) less than 2.0 L/min/m(2) with left atri al pressure greater than 18 mmHg despite the use of IABP and maximum p harmacologic support. Blood temperature was maintained at around 33 de grees 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 ran ged from thirty-six to one hundred fifty-nine hours with a mean of sev enty-eight hours. All 8 patients finally discontinued IABP support wit h a mean driving time of one hundred thirty-two hours. Five of them we re ultimately discharged from the hospital and returned to their previ ous life-style. The authors believe that, from the perspective of mone tary and personal resources, the use of hypothermia with IABP support could be a therapeutic option for patients with postcardiotomy ventric ular failure.