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Ann Thorac Surg 2001;72:1940-1944
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Conventional carbon dioxide application does not reduce cerebral or myocardial damage in open heart surgery

^a Department for Thoracic and Cardiovascular Surgery, University Hospital J. W. Goethe, Frankfurt am Main, Germany

Accepted for publication August 8, 2001.

* Address reprint requests to Dr Martens, Klinikum der J. W. Goethe-Universität, Klinik für Thorax-Herz und thorakale Gefäßchirurgie, Theodor Stern Kai 7, D-60590 Frankfurt am Main, Germany
e-mail: martens.herz{at}gmx.de

Background. Open heart surgery is associated with a significant risk of cerebral and myocardial dysfunction, which is attributed in part to air embolism from incompletely deaired cardiac chambers. To evaluate the impact of carbon dioxide (CO₂) insufflation to the thoracic cavity, a prospective randomized study was designed.

Methods. A total of 62 elective patients were randomly assigned to CO₂ insufflation (group I, n = 31) or control (group II, n = 31). According to the Parsonnet risk score, 16 patients in group I (52%) and 10 patients in group II (32%) were categorized as being at either high risk or extremely high risk.

Results. In group II, perioperative mortality was 16.1% (5 patients); in group I, 1 patient died (ns). Creatine kinase MB isoenzyme, as a marker of myocardial damage, was more elevated in group I after surgery (38.0 ± 4.1 vs 28.0 ± 2.1, p = 0.02). Neurocognitive test scores did not reveal significant postoperative differences between groups.

Conclusions. Although mortality was lower with CO₂ insufflation, no benefit could be demonstrated for markers of cardiac ischemic damage or neurocognitive outcome in this high-risk population. As CO₂ concentrations in the thoracic cavity did not necessarily reach anticipated levels, our method of application is in question.

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