SELECTION OF THE MODE OF CARDIOPULMONAY BYPASS IN AGED AND GERIATRIC PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING

Abstract

Despite continuous improvement in devices and a better understanding of the mechanisms underlying the pathophysiology of cardiopulmonary bypass (CPB), which led to a general improvement in patient outcomes, some aspects of CPB are controversial. These controversial aspects of CPB are related to the question of the mechanism and nature of blood delivery to the patient, for example, which blood circulation mode should be used - pulsative or non-pulsative. Object and methods. This study included 320 patients with ischemic heart disease, was conducted on basis of “Heart Institute of Ministry of Health of Ukraine”. It was used coronary artery bypass grafting with applying 2-3 aorto-coronary anastomoses under conditions of cardiopulmonary bypass. The average age of patients is 68.1 ± 2.9 years. Depending on the mode of flow with CPB, patients are divided into two groups: the first – 152 patients using the pulsative mode; the second – 168 patients with non-pulsative blood flow. CPB was performed on a System 1 (Terumo, USA) apparatus using Affinity disposable membrane oxygenators (Medtronic, USA) under conditions of moderate hypothermia (32°Ñ). Results. In patients who used non-pulsative blood flow, index of systemic vascular resistance value is significantly higher compared with patients who used pulsative blood flow. The oxygen consumption index in patients who underwent CPB with a pulsative flow at the end of artificial fibrillation was significantly higher compared to its value at the beginning of fibrillation. The level of creatinine in both study groups after 24 and 48 hours was significantly higher compared with baseline data. Conducting CPB with a non-pulsative flow was characterized by a significantly higher by 17.82% (p=0.048) creatinine level 24 hours after the operation compared with the use of pulsative blood flow, however, the value of this indicator was within the reference limits. Conclusions. Although we didn’t establish any specific reliable benefits in aged and geriatric patients with CABG with a pulsative mode as compared to non-pulsative one, it is worth noting that with this blood flow mode, higher oxygen consumption and moderate changes in biochemical parameters were observed.

Keywords

• ishemic heart disease
• coronary artery bypass grafting
• cardiopulmonary bypass
• aged and geriatric patients.