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Shukri F. Khuri
Robert K. Brawley
John B. O'Riordan
James S. Donahoo
Vincent L. Gott
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Ann Thorac Surg 1975;20:661-670
© 1975 The Society of Thoracic Surgeons

Articles

The Effect of Cardiopulmonary Bypass Perfusion Pressure on Myocardial Gas Tensions in the Presence of Coronary Stenosis

Shukri F. Khuri, M.D., Robert K. Brawley, M.D.*, John B. O'Riordan, M.D., James S. Donahoo, M.D., Bertram Pitt, M.D., Vincent L. Gott, M.D.

From the Departments of Surgery and Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md

* Address reprint requests to Dr. Brawley, Blalock 608, The Johns Hopkins Hospital, Baltimore, Md. 21205

Mass spectrometry was utilized to determine myocardial gas tensions in dogs subjected to cardiopulmonary bypass. Myocardial ischemia occurred in animals with normal coronary arteries when cardiopulmonary bypass perfusion pressure fell 40 to 60 mm Hg below the mean aortic pressure measured prior to bypass. Myocardial ischemia did not occur, or could be eliminated when present, if cardiopulmonary bypass perfusion pressure was maintained near prebypass mean aortic pressure. In animals with constricted circumflex coronary arteries, the adverse effect of low perfusion pressure on myocardial metabolism during cardiopulmonary bypass was found to be more severe in areas of myocardium supplied by the stenotic coronary artery. It is concluded that maintenance of cardiopulmonary bypass perfusion pressure near the level of preoperative mean aortic pressure will help prevent myocardial ischemia during operation, particularly in patients with coronary artery disease.




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