Superior extension of intraoperative brain damage in case of normothermic systemic perfusion during coronary artery bypass operations

Objective: Despite the controversies on the potential detrimental effects o f normothermic cardiopulmonary bypass on neurologic: outcome, to date no co rrelation between the severity of intraoperative brain lesions and the card iopulmonary bypass temperature used at operation has been reported. This st udy compares the prevalence and the severity of brain lesions in patients w ho underwent operation in condition of normothermic versus hypothermic syst emic perfusion, Methods: Data are derived from the analysis of 2987 consecu tive primary isolated myocardial revascularizations performed at our instit ution between April 1990 and January 1997, Of these cases, 1385 procedures were hypothermic and 1602 procedures were:normothermic systemic perfusion. In all cases the neurologic outcome and extent of ischemic areas were prosp ectively recorded, Results: Overall, 31 patients had a perioperative stroke (1.0%). The prevalence of neurologic events was similar in the 2 groups (I f cases in the hypothermic group and 16 cases in the normothermic perfusion group; P, not significant), However, the mean Glasgow Outcome Scale score and computed tomography-demonstrated extent of brain lesions mere significa ntly worse in the normothermic group, Conclusions: Although the prevalence of intraoperative stroke was similar with hypothermic or normothermic cardi opulmonary bypass, the use of normothermic systemic perfusion was associate d with more extended brain damage at computed tomographic scan and with a w orse neurologic outcome, These results demand caution in the use of normoth ermic cardiopulmonary bypass and claim further investigation on the neurolo gic safety of normothermia.