Cardiovascular Journal of Africa: Vol 25 No 2(March/April 2014) - page 34

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014 72 AFRICA
of this process, cell death may occur in time. 18 In another study,
Conno et al . reported that topical cooling with iced saline may
cause epicardial oedema via a hypothermic–hypo-osmolar effect
and may create temporary ST-segment anomalies on ECG
without myocardial functional disorders.19 We did not see any
significant abnormalities in ECG or echocardiography in our
study.
Hamulu et al. reported that pre-operative cardiac dysfunction
was an important risk factor for heart surgery and reported that
mortality and morbidity rates were almost higher in patients with
pre-operative EF < 35%.20 We excluded the patients with < 35%
EF from our study for realistic results.
None of our patients had major complications such as
cerebrovascular events, renal insufficiency or infection. A
58-year-old male patient in group I, treated for diabetes mellitus
and hypertension, was dead on postoperative day 18 due to
cardiac and respiratory arrest at home. When we compared
the risk factors of peri-operative mortality such as age, gender,
concomitant diseases, myocardial function, EF and surgical
parameters,21 we did not find any correlation between this patient
and the remaining patients in either group.
Conclusion
Although this was a randomised, controlled, prospective study,
due to the small number of patients, it was not possible to make
generalised comments regarding the results. Therefore, there is
a need to perform more randomised studies with larger patient
numbers.
Since topical hypothermia was the only variable in the
present study, it was shown to increase inflammatory activity.
Therefore topical hypothermia had deleterious effects on the
postoperative course, which affects postoperative morbidity and
patient outcome.
References
1. Kirklin JW, Barrat-Boyes BG. Hypothermia, circulatory arrest and
cardiopulmonary bypass. Cardiac Surgery, 3rd edn. Philadelphia:
Churchill Livingstone, 2003: 66–130.
2. Abacilar F, Dogan OF, Duman U, Ucar I, Demircin M, Ersoy U, et al .
The changes and effects of the plasma levels of tumor necrosis factor
after coronary artery bypass surgery with cardiopulmonary bypass.
Heart Surg Forum 2006; 9: 703–709.
3. Cassese M, Martinelli G, Nasso G, Anselmi A, De Filippo CM, Braccio
M, et al. Topical cooling for myocardial protection: the results of a
prospective randomized study of the “shallow technique”. J Card Surg
2006; 21: 357–362.
4. Nikas DJ, Ramadan FM, Elefteriades JA. Topical hypothermia: inef-
fective and deleterious as adjunct to cardioplegia for myocardial protec-
tion. Ann Thorac Surg 1998; 65: 28–31.
5. Minatoya K, Okabayashi H, Shimada I, Tanabe A, Nishina T, Nandate
K, et al. Intermittent antegrade warm blood cardioplegia for CABG:
extended interval of cardioplegia. Ann Thorac Surg 2000; 69: 74–76.
6. Wimmer-Greinecker G, Matheis G, Martens S, Oremek G, Abdel-
Rahman U, Moritz A. Synthetic protein treated versus heparin coated
cardiopulmonary bypass surfaces: similar clinical results and minor
biochemical differences. Eur J Cardio Thorac Surg 1999; 15: 1–7.
7. Walport MJ. Complement. N Eng J Med 2001; 344: 1058.
8. Akgün S. Eri şkin Kalp Cerrahisinde Miyokard Korunması. Duran
E (ed). Kalp ve damar cerrahisi. Birinci baskı. İstanbul: Çapa Tıp
Kitabevi, 2004: 1091–1106.
9. Lichtenstein SV, Ashe KA, El Dalati H, Cusimao RJ, Slutsky AS.
Warm heart surgery. J Thorac Cardiovasc Surg 1991; 101: 269–274.
10. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et
al. A multicenter risk index for atrial fibrillation after cardiac surgery.
J Am Med Assoc 2004; 14: 1720–1729.
11. Nisanoglu V, Erdil N, Aldemir M, Ozgur B, Berat CH, Yologlu S, et
al. Atrial fibrillation after coronary artery bypass grafting in elderly
patients: incidence and risk factor analysis. Thorac Cardiovasc Surg
2007; 55: 32–38.
12. Koch CG, Li L, van Wagoner DR, Duncan AI, Gillinov AM,
Blackstone EH. Red cell transfusion is associated with an increased
risk for postoperative atrial fibrillation. Ann Thorac Surg 2006; 82:
1747–1756.
13. Edgerton JR, Herbert MA, Prince SL, Horswell JL, Michelson L,
Magee MJ, et al. Reduced atrial fibrillation in patients immediately
extubated after off-pump coronary artery bypass grafting. Ann Thorac
Surg 2006; 81: 2121–2126.
14. Canbaz S, Ege T, Sunar H, Çıkırıkçıoğlu M, Edis M, Duran E. Koroner
arter cerrahisi sonrası atrial fibrilasyon gelişimindeki belirleyicilerin
irdelenmesi. Türk Göğüs Kalp Damar Cer Derg 2000; 8: 767–770.
15. Calafiore AM, Teodori G, Mezzetti A, Bosco G, Verna AM, Di
Giammarco G, et al. Intermittent antegrade warm blood cardioplegia.
Ann Thorac Surg 1995; 59: 398–402.
16. O’Brien JW, Johnson SH, van Steyn SJ, Craig DM, Sharpe RE,
Mauney MC, Smith PK. Effects of internal mammary artery dissection
on phrenic nerve perfusion and function. Ann Thorac Surg 1991; 52:
182–188.
17. Tripp H, Bolton JWR. Phrenic nerve injury following cardiac surgery:
A review. J Card Surg 1998; 13: 218–223.
18. Robicsek F, Duncan GD, Rice HE, Robicsek SA. Experiments with a
bowl of saline: the hidden risk of hypothermic-osmotic damage during
topical cardiac cooling. J Thorac Cardiovasc Surg 1989; 97: 461–466.
19. Corno A, Zoia E, Santoro F, Camesasca C, Biagioli B, Grossi A.
Epicardial damage induced by topical cooling during pediatric cardiac
surgery. Br Heart J 1992; 67: 174–176.
20. Hamulu A, Özbaran M, Atay Y, Pasacıoğlu H, Aras I, Buket S.
Koroner Bypass Ameliyatında Mortalite ve Morbiditeye Etki Eden
Risk Faktörlerinin Belirlenmesi ve Değerlendirilmesi. Türk Göğüs
Kalp Damar Cer Derg 1995; 3: 245–52.
21. Bakalım T.Açık Kalp Cerrahisi Sonrası Sık Karşılaş ılan
Komplikasyonlar. Duran E (Ed). Kalp ve damar cerrahisi. Birinci
baskı. İstanbul: Çapa Tıp Kitabevi, 2004: 1151–1162.