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Ann Thorac Surg 1996;61:1328-1329
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 1323.

DR RICHARD D. WEISEL (Toronto, Ont, Canada): I appreciate the opportunity to discuss this elegant study from the group at Cornell University in New York. Your study was recently published in the New England Journal of Medicine and is a beautifully designed and executed trial comparing T3 to placebo therapy for patients undergoing coronary artery bypass grafting. You found improvement in cardiac index early postoperatively. However, you were careful to avoid claiming a clinical benefit from perioperative T3 treatment. Your caution was emphasized in the accompanying editorial, which suggested no clinical benefit to the perioperative use of T3. What is your current indication for T3 use? Would patients who have poor ventricular function and are at high risk for a low output syndrome coming off bypass benefit from perioperative T3 treatment?

You were surprised to find a significant reduction in the incidence of superventricular arrhythmias in the T3-treated patients. You have not been able to identify the reason for the reduced incidence of arrhythmias. In previous studies from our institution, we found that cardioplegic interventions intended to improve atrial protection did not reduce the incidence of perioperative arrhythmias. However, cardioplegic interventions that reduced perioperative ischemic injury (creatine kinase-MB release) and improved early postoperative ventricular function reduced the prevalence of postoperative atrial arrhythmias from 42% to 18% (p < 0.01). In your study T3 improved postoperative ventricular function and decreased the prevalence of atrial arrhythmias from 46% to 24% (p < 0.01). Therefore, do you believe T3 improved perioperative protection and in this way reduced postoperative arrhythmias? Do you have any creatine kinase-MB measurements in your patients that would indicate whether there was a difference in perioperative ischemic injury?

Finally, do you believe that T3 should be used prophylactically to prevent postoperative arrhythmias?

DR KLEMPERER: . . . [Full Text of this Article]

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