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Ann Thorac Surg 1984;38:514-519
© 1984 The Society of Thoracic Surgeons

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Articles

Disadvantages of Prostacyclin Infusion During Cardiopulmonary Bypass: A Double-Blind Study of 50 Patients Having Coronary Revascularization

Departments of Surgery and Anesthesia, Harvard Medical School and Brigham and Women's Hospital, Boston, MA.

¹ Address reprint requests to Dr. Cohn, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Prostacyclin (PGI₂) has been suggested for use in cardiopulmonary bypass (CPB) because of its positive effects on platelet number and function. Fifty patients who underwent coronary artery bypass grafting using a bubble oxygenator received heparin, 3 mg per kilogram of body weight, and then were randomly assigned to receive PGI₂, 25 ng/kg/min, beginning 5 minutes before and until the end of CPB (26 patients) or a placebo (24 patients). Both groups were similar in sex, age, heparin dose, protamine dose, and CPB time. During CPB, mean arterial pressure fell significantly with PGI₂ (76 ± 2 mm Hg to 53 ± 2 mm Hg; p < 0.05) and necessitated pressor substances. Platelet counts fell significantly in both groups with the start of CPB, but after 60 minutes were similar in both groups (118 ± 9 x 10³ versus 130 ± 8 x 10³; not significant [NS]) and were unchanged 3 hours after CPB. Total chest tube output was 647 ± 51 ml (placebo group) versus 576 ± 34 ml (PGI₂ group) (NS); 18 of the patients given PGI₂ required 26 transfusions compared with 16 transfusions in 8 of the patients given a placebo (p < 0.05). In PGI₂ patients, arterial oxygen tension on 100% oxygen fell from 281 ± 18 mm Hg before CPB to 223 ± 17 mm Hg immediately after CPB (p < 0.05). The placebo patients did not show a change in this variable. There was a significant rise in thromboxane B₂ (TXB₂) from 150 ± 30 to 360 ± 60 pg/ml (p < 0.05) during CPB in PGI₂ patients but it was not significantly increased in the placebo group (180 ± 30 to 270 ± 40 pg/ml; NS).

At 25 ng/kg/min, PGI₂ has no demonstrable beneficial effect on platelet count or postoperative bleeding in patients having elective cardiac operations. Deleterious effects on mean arterial pressure, arterial oxygen tension, and TXB₂ levels during and after CPB are associated with administration of PGI₂ at this dosage.

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