Toshiya Ohtsuka, Mikio Ninomiya, Takahiro Nonaka.
Tokyo Metropolitan Fuchu Hospital, Tokyo, Japan.
Introduction: Hypothermia is a disadvantage of off-pump coronary artery bypass (OPCAB). A low body temperature can cause acidosis and incur unfavorable complications such as bleeding tendency, coronary spasm and prolonged postoperative intubation. We have developed a left pleural warmer (LPW) to overcome this problem. Herein, the clinical outcomes are described.
Materials and Methods: The LPW system was fabricated with materials available from the ready-made products: the warming bag for a hemodialysis circuit (12x16x0.5 cm, UBE, Japan) connected with the MERA cardioplegic solution supplying system with a heat exchanger (HCP-5000, SENKO MEDICAL, Japan). Sterilized normal saline warmed at forty degree centigrade was circulated in the LPW system and the warming bag was introduced through a median full-sternotomy into the left thoracic cavity and placed alongside the descending aorta. A temperature of the bladder was monitored continuously, an injected dose of bicarbonate and a volume of blood loss were counted during surgery, and a postoperative intubation period was recorded. Since June 2007, the LPW was applied to thirty-eight consecutive OPCAB cases (22 male, 16 female, 70.1±7.8 years old), and the clinical consequences were compared with 100 consecutive OPCAB cases operated prior to the LPW (64 male, 36 female, 68.5±10.4 years old).
Results: There was no LPW-related complication. In the LPW group, the bladder temperature dropped in no patients and, three hours after sternotomy, rose by 0.55±0.3 degree centigrade on the average, while in the control group the temperature dropped in all cases by 1.04±0.4 degree centigrade, and the difference was statistically significant. There was no statistic difference between both groups in the use of the bicarbonate, blood loss, and intubation period, but all the same the LPW cohort earned tendencies of less use of bicarbonate (less acidosis), smaller hemorrhage, and shorter intubation: 12.5±5.5 ml/hour vs. 18.6±10.8 ml/hour, 90.5±20.3 ml/hour vs. 119±28.8 ml/hour and 4.9±2.8 hours vs. 7.2±4.9 hours.
Conclusion: The LPW technique was safely applied to the OPCAB cases and the bladder temperature was unchanged or even elevated. This technique can be a viable preventive method to eschew the hypothermia of the patients undergoing OPCAB.
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