CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
AFRICA
69
study. The mean age of the patients was 62.8
±
9.9 years (40–80)
in group I, and 57.7
±
9.4 years (39–84) in group II. With regard
to demographic data of the patients, there was no significant
difference between the groups other than hypertension. The
pre-operative demographic data are given in Table 1.
There was no statistically significant difference between
the groups with regard to surgical data (
p
>
0.05). Mean aortic
cross-clamp time was 55.76
±
23.2 min in group I, and 53.44
±
16.7 min in group II. The LIMA was used in 19 patients in group
I and in 20 patients in group II. The right coronary artery was
revascularised in 14 patients in both groups. Surgical data are
given in Table 2.
Excluding C3 and TNF-
α
levels in the time-dependent
analysis, there were no statistically significant differences
between any blood parameters. When we analysed the changes in
C3 and TNF-
α
levels at every time point and the time-dependent
changes, there was a statistically significant difference in favour
of group II (C3:
p
<
0.05, TNF-
α
:
p
<
0.001). The blood sample
results and time-dependent changes are given in Table 3 and Figs
1 and 2.
There was a statistically significant difference between the
groups with regard to spontaneous defibrillation of the heart.
Sinus rhythm was spontaneously restored in 20 patients in group
II, and in only eight in group I (
p
<
0.01).
Atrial fibrillation postoperatively was seen in six patients in
group I, and in only one patient in group II (
p
<
0.05). There
was no significant difference between the groups with regard to
other rhythm disorders (
p
>
0.05). There were four patients who
needed IABP support in group I, whereas no patient needed this
in group II (
p
<
0.05).
In group I, seven patients had diaphragm elevation as a
consequence of diaphragm paralysis, while none of the patients
had diaphragm complications in group II (
p
<
0.01). There
was no significant difference between the groups with regard
to rates of partial pericardiotomy and LIMA use, which could
have caused these diaphragm complications. Comparison of the
patients’ data is given in Table 4.
The necessity of using positive inotropes, ICU statistics,
drainage and transfusion amounts, ECG and echocardiography
changes, hospital length of stay and the other postoperative data
are given in Table 5. Overall there was no statistically significant
difference between the groups with regard to these categories (
p
>
0.05).
Discussion
Initially, most cardiac surgeons believed that topical cooling
was effective in cardiac performance as it increased myocyte
Table 1. Pre-operative demographic data of the patients.
Demographics
Group I (
n
=
25) Group II (
n
=
25)
p
-value
Age (year)
62.8
±
9.9
57.7
±
9.4
>
0.05
Gender (male/female)
22/3
20/5
>
0.05
Height (cm)
169.8
±
6.52
166.24
±
6.11
>
0.05
Weight (kg)
76.4
±
9.03
78.4
±
9.93
>
0.05
BSA
1.868
±
0.11
1.852
±
0.11
>
0.05
DM (
n
)
6
8
>
0.05
HT (
n
)
9
16
< 0.05
Dyslipidaemia (
n
)
8
10
>
0.05
PAD (n)
1
1
>
0.05
COPD (
n
)
2
4
>
0.05
Renal failure (
n
)
0
1
>
0.05
Pre-operative EF (%)
55.4
±
7.79
54.6
±
7.02
>
0.05
Table 2. Intra-operative data of the patients.
Group I (
n
=
25) Group II (
n
=
25)
p-
value
X clamp time (min)
55.76
±
23.2
53.44
±
16.7
>
0.05
Total perfusion time (min) 106.44
±
40.5 104.28
±
28.06
>
0.05
Hypothermia (°C)
28.7
±
0.93
28.8
±
0.92
>
0.05
Cold cardioplegia (ml)
1035.6
±
360.17 1014
±
242.2
>
0.05
Hot cardioplegia (ml)
398
±
82.25
414
±
70
>
0.05
Distal anastomosis (
n
)
3 (2–6)
3 (2–5)
>
0.05
Proximal anastomosis (
n
)
2 (1–4)
2 (1–5)
>
0.05
LIMA use (
n
)
19
20
>
0.05
RCA revascularisation (
n
)
14
14
>
0.05
Table 3. Blood sample results of the patients.
Sample type Time
Group I (
n
=
25) Group II (
n
=
25)
p-
value
TnI
(ng/ml)
Pre-op
0.314
±
0.97 0.204
±
0.35
>
0.05
Basal
0.326
±
0.755 0.296
±
0.251
>
0.05
Ischaemia
0.602
±
0.886 0.415
±
0.337
>
0.05
Reperfusion 0.938
±
0.85 0.782
±
0.372
>
0.05
8th hour
1.475
±
0.479 1.09
±
0.604
>
0.05
24th hour
1.51
±
1.343 1.113
±
0.854
>
0.05
TnT
(ng/ml)
Pre-op
0.155
±
0.497 0.042
±
0.057
>
0.05
Basal
0.149
±
0.420 0.162
±
0.208
>
0.05
Ischaemia
0.294
±
0.603 0.201
±
0.176
>
0.05
Reperfusion 0.330
±
0.65 0.339
±
0.204
>
0.05
8th hour
0.495
±
0.725 0.367
±
0.235
>
0.05
24th hour
0.417
±
0.59 0.331
±
0.217
>
0.05
Myoglobin
(ng/ml)
Pre-op
43.24
±
48.789 30.368
±
8.470
>
0.05
Basal
71.911
±
40.82 91.028
±
36.53
>
0.05
Ischaemia 105.06
±
53.35 137.02
±
50.49
>
0.05
Reperfusion 199.068
±
88.52 253.22
±
69.395
>
0.05
8th hour
156.17
±
67.164 170.93
±
81.62
>
0.05
24th hour
256.63
±
196.79 233.48
±
113.867
>
0.05
CK
(U/l)
Pre-op
98.28
±
98.99 91.56
±
55.49
>
0.05
8th hour
411.04
±
130.087 448.6
±
181.39
>
0.05
24th hour
624.6
±
245.75 599.21
±
256.73
>
0.05
CK-MB
(U/l)
Pre-op
13.32
±
5.49 14.68
±
4.63
>
0.05
8th hour
23.84
±
6.414 24.8
±
4.76
>
0.05
24th hour
20.88
±
8.31
25.2
±
8.225
>
0.05
LDH
(U/l)
Pre-op
381.12
±
61.42 378.32
±
91.13
>
0.05
8th hour
518.12
±
103.39 538.04
±
129.84
>
0.05
24th hour
610.12
±
110.98 581.84
±
132.92
>
0.05
C3
(g/l)
Basal
0.6436
±
0.119 0.601
±
0.979
<
0.05
Ischaemia
0.623
±
0.104 0.592
±
0.116
<
0.05
Reperfusion 0.593
±
0.817 0.601
±
0.876
<
0.05
C4
(g/l)
Basal
0.115
±
0.219 0.107
±
0.06
>
0.05
Ischaemia
0.114
±
0.20 0.109
±
0.52
>
0.05
Reperfusion 0.109
±
0.203 0.1068
±
0.50
>
0.05
TNF-a
(pg/ml)
Basal
8.566
±
0.642 8.516
±
0.722
<
0.001
Ischaemia
9.556
±
0.879 8.577
±
0.676
<
0.001
Reperfusion 8.846
±
0.602 8.544
±
0.48
<
0.001
