Effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing valvular heart surgery.
10.4097/kjae.2010.58.2.122
- Author:
Jeong Soo LEE
1
;
Jong Chan KIM
;
Joo Young CHUNG
;
Seong Wook HONG
;
Kil Hwan CHOI
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ylkwak@yuhs.ac
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Oxygen tension;
Reperfusion injury;
Valvular heart surgery
- MeSH:
Anesthesia;
Cardiopulmonary Bypass;
Heart;
Heart Arrest, Induced;
Hemodynamics;
Humans;
Length of Stay;
Milrinone;
Norepinephrine;
Oxygen;
Prognosis;
Reperfusion;
Reperfusion Injury;
Sternum;
Thoracic Surgery;
Vasopressins;
Weaning
- From:Korean Journal of Anesthesiology
2010;58(2):122-128
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Valvular heart surgery (VHS) utilizing cardiopulmonary bypass (CPB) is inevitably associated with ischemic-reperfusion injury, which is known to depend on oxygen tension during reperfusion. The aim of this study was to evaluate the effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing VHS. METHODS: Fifty-six patients undergoing isolated VHS were randomly exposed to an oxygen fraction of 0.7 (hyperoxic group, n = 28) or 0.5 (normoxic group, n = 28) during reperfusion. All patients received an oxygen fraction of 0.7 during CPB. In the normoxic group, the oxygen fraction was lowered to 0.5 from the last warm cardioplegia administration to 1 minute after aortic unclamping, and was then raised back to 0.7. Hemodynamic data were measured after induction of anesthesia, weaning from CPB, and sternum closure. The frequency of cardiotonic medications used during and after weaning from CPB, and the short-term outcomes during the hospital stay were also assessed. RESULTS: The frequency of vasopressin and milrinone use during weaning from CPB, but not norepinephrine, was significantly less in the normoxic group. The post-operative cardiac enzyme levels and short-term outcomes were not different between the groups. CONCLUSIONS: Normoxic reperfusion from the last cardioplegia administration to 1 minute after aortic unclamping in patients undergoing VHS resulted in significantly less frequent use of vasopressin and inotropics during weaning from CPB than hyperoxic reperfusion, although it did not affect the post-operative myocardial enzyme release or short-term prognosis.
