| Determinants of regional myocardial acidosis during cardiac surgery. | |
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MedLine Citation:
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PMID: 15300179 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Intraoperative regional myocardial acidosis (RMA) during cardiac surgery has been shown to be reflective of regional myocardial ischemia and an independent predictor of adverse postoperative outcomes. This study identifies the determinants of intraoperative RMA. METHODS: Intramyocardial tissue pH(37C) in the anterior and posterior LV walls was measured in 641 adult patients during cardiac surgery. RMA at two intraoperative periods was quantified as integrated mean pH(37C) < 6.35 during aortic clamping (AC) and pH(37C) < 6.73 at the end of cardiopulmonary bypass (CPB). These pH thresholds were chosen because of their demonstrated relationship to long-term patient survival. Multivariate logistic regression models were constructed. An acidosis prediction score was constructed based on the factors determining RMA at the end of CPB. RESULTS: Independent determinants of RMA during AC were preoperative New York Heart Association class III/IV (P = .007), current smoker (P = .0088), pH(37C) < 6.63 prior to AC (P < .0001), and intraoperative myocardial management technique (P = .0001). Independent determinants of RMA at end of CPB were ASA class IV/V (P = .0042), pH(37C) < 6.63 prior to AC (P = .035), pH(37C) < 6.35 during AC (P = .001), and total duration of CPB > or = 212 minutes (P = .001). CONCLUSIONS: RMA during cardiac surgery is determined by patient risk factors, the magnitude of preceding regional myocardial acidosis, and the duration of CPB. |
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Authors:
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Dharam J Kumbhani; Nancy A Healey; Vladimir Birjiniuk; Michael D Crittenden; Miguel Josa; Patrick R Treanor; Shukri F Khuri |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Surgery Volume: 136 ISSN: 0039-6060 ISO Abbreviation: Surgery Publication Date: 2004 Aug |
Date Detail:
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Created Date: 2004-08-09 Completed Date: 2004-08-24 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: United States |
Other Details:
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Languages: eng Pagination: 190-8 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2004 Elsevier Inc. |
Affiliation:
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Surgical Service, VA Boston Healthcare System, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA 02132,USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acidosis
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etiology* Adult Aged Cardiac Surgical Procedures / adverse effects* Cardiopulmonary Bypass / adverse effects Coronary Artery Bypass / adverse effects Female Humans Hydrogen-Ion Concentration Intraoperative Complications / etiology* Male Middle Aged Multivariate Analysis Myocardium / metabolism* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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