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Ann Thorac Surg 2001;72:S2233-S2234
© 2001 The Society of Thoracic Surgeons

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Supplement: Monitoring and improving patient safety during and following cardiac surgery

Discussion

^a Surgical Service, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA

e-mail: shukri.khuri@med.va.gov

I would like to supplement Dr Khabbaz’s presentation with a discussion related to a very frequently asked question, which Dr Khabbaz did not address in his excellent talk. In fact, the most frequently asked questions about myocardial pH monitoring are the following: When you observe, in the course of a cardiac surgical operation, that the pH in the anterior or posterior wall of the left ventricle is falling to low levels, can you do anything about it? How can you intervene to reverse myocardial acidosis, or even eliminate it all together, in both the anterior and posterior walls of the left ventricle? In the next five minutes, I will try to address both of these questions.

Our group has been measuring myocardial pH in humans since 1982. Since then, we have acquired an experience in intraoperative myocardial pH monitoring based on more than 700 mostly complex, cardiac surgical patients in whom we measured pH continuously, simultaneously in both the anterior and posterior left ventricular walls. In the initial tercile of these patients, we were learning what these measurements meant by simply recording the pH values and correlating them later with clinical events. In this group of patients, we observed frequently progressive acidosis that led to very low levels of myocardial pH during both the period of aortic clamping and the period of reperfusion after aortic clamp . . . [Full Text of this Article]

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