S. Martens et al., Conventional carbon dioxide application does not reduce cerebral or myocardial damage in open heart surgery, ANN THORAC, 72(6), 2001, pp. 1940-1944
Citations number
18
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Background. Open heart surgery is associated with a significant risk of cer
ebral and myocardial dysfunction, which is attributed in part to air emboli
sm from incompletely deaired cardiac chambers. To evaluate the impact of ca
rbon dioxide (CO2) insufflation to the thoracic cavity, a prospective rando
mized study was designed.
Methods. A total of 62 elective patients were randomly assigned to CO2 insu
fflation (group I, n = 31) or control (group II, n = 31). According to the
Parsonnet risk score, 16 patients in group I (52%) and 10 patients in group
II (32%) were categorized as being at either high risk or extremely high r
isk.
Results. In group II, perioperative mortality was 16.1% (5 patients); in gr
oup I, 1 patient died (ns). Creatine kinase MB isoenzyme, as a marker of my
ocardial damage, was more elevated in group I after surgery (38.0 +/- 4.1 v
s 28.0 +/- 2.1, p = 0.02). Neurocognitive test scores did not reveal signif
icant postoperative differences between groups.
Conclusions. Although mortality was lower with CO2 insufflation, no benefit
could be demonstrated for markers of cardiac ischemic damage or neurocogni
tive outcome in this high-risk population. As CO2 concentrations in the tho
racic cavity did not necessarily reach anticipated levels, our method of ap
plication is in question. (C) 2001 by The Society of Thoracic Surgeons.